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DRUG ADMINISTARTION
ASMA FALAK
MSN(Silver Medal), PRN,CCN(Silver Medal),RM,RN
Nursing Instructor
School of Nursing & Midwifery
PIMS, Islamabad
Asma Falak/SON, PIMS 1
• A medication is a substance
administered for the diagnosis,
cure, treatment, or relief of a
symptom or for prevention of
disease.
• Pharmacology is the study of the
effect of drugs on living organisms.
• Prodrug:
Asma Falak/SON, PIMS 2
• The written direction for the preparation
and administration of a drug is called a
prescription.
Asma Falak/SON, PIMS 3
Purpose of Medication
Asma Falak/SON, PIMS 4
Drugs can be administered for these
purposes:
• Diagnostic purpose: To identify any
disease
• Prophylaxis: To prevent the occurrence of
the disease e.g. heparin to prevent thrombosis
or antibiotic to prevent infection.
• Therapeutic Purpose: To cure the disease.
Uses of Drugs
Asma Falak/SON, PIMS 5
⚫ Prevention- used as prophylaxis to prevent
diseases e.g. vaccines; fluoride-prevents tooth
decay.
⚫Diagnosis- establishing the patient’s disease
or problem e.g. radio contrast dye; tuberculosis
(Mantoux) testing.
⚫Suppression- suppresses the signs and
symptoms and prevents the disease process
from progressing e.g. anticancer, antiviral
drugs.
⚫Treatment- alleviate the symptoms for
patients with chronic disease e.g. Anti-
asthmatic drugs.
⚫Cure- complete eradication of diseases e.g.
anti-biotics, anti-helmintics.
⚫Enhancement aspects of health- achieve
the best state of health e.g. vitamins,
minerals.
Asma Falak/SON, PIMS 6
Legal Aspects of Medication
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⚫ Preparation, dispensing and administration of
medications are all covered by laws in every
country.
⚫ Dangerous drugs are always kept under lock and
key in the Dangerous Drug Cupboard under the
care of trusted senior nurses.
 Dangerous Drug Act – 1930 and The Narcotic
Drugs and Psychotropic Substances Act - 1985. It
is an act that governs the procurement and use of
some drugs especially the narcotics e.g. morphine,
pethedine, cocaine etc. These drugs are prescription
only drugs hence cannot be bought or administered
without prescription.
Asma Falak/SON, PIMS 8
⚫It is worth knowing that nurses are
responsible for their own actions regardless
of the presence of a written order. If a
nurse gives an overdose of a drug because it
is written by a doctor, the error is accounted
to the nurse and not the doctor. The nurse
should bear in mind that ALL substances
are poisons: there is none that is not a
poison. The right dose differentiates a
poison from a remedy.
Asma Falak/SON, PIMS 9
Drug Nomenclature
Asma Falak/SON, PIMS 10
One drug can have as much as 4 different
names as follows:
⚫Chemical Name - any typical organic name;
this precisely describes the constituents of
the drug
⚫E.g. N-(4-hydroxyphenyl)acetamide for
paracetamol
• Generic Name - is given by the
manufacturer who first develops the drug; it
is given before the drug becomes official. It
is the name by which the drug will be
known throughout the world no matter how
many companies manufacture it. This name
is usually agreed upon by the WHO. Often
the generic name is derived from the
chemical name. E.g. acetaminophen
Asma Falak/SON, PIMS 11
• Official Name – United States Adopted
Name (USAN) or Japanese Accepted Name
(JAN). It will also apply for an International
Nonproprietary Name (INN) through the
World Health Organization (WHO).
Trade Name:
Asma Falak/SON, PIMS 12
Classification of Medication
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Medications may be classified according to:
⚫ The body system that the medicine is targeted
to interacts wit; e.g. cardiovascular
medications, nervous system medication etc.
⚫ Therapeutic usages of the medicine; e.g.
antihypertensives ,neuroleptics,
⚫The diseases the medicine is used for; e. g.
anticancer drugs, antimalaria drugs
antihelminthics etc.
• The action of the medication can also be
used to classify the it; e.g. beta-adrenergic
blocking agents
• The overall effect of the medication on the
body can also be a criteria for its
classification; e.g. sedatives, antianxiety
drugs etc.
Asma Falak/SON, PIMS 14
Drug Metabolism
 Drug Metabolism in human body is accomplished in
four basic stages;
I. Absorption
II. Transportation
III. Biotransformation
IV. Excretion
Asma Falak/SON, PIMS 15
Absorption
 The process by which the drug moves into the body
from external source until it is absorbed in the circulation.
 Drugs are absorbed through; mucous membrane,
gastrointestinal, respiratory tract and skin.
 Absorption depends on the PH of the stomach, contents of
food and presence of disease.
 IV is the fastest route for drug absorption.
Asma Falak/SON, PIMS 16
Transportation
 The way in which a drug is transported from the site
of introduction to the site of action.
 It binds to a specific plasma protein in the blood and
transported to the body parts.
 It depends upon the permeability of the membranes
and the blood supply to the absorption area.
Asma Falak/SON, PIMS 17
Biotransformation
 Drug is converted by enzymes into a less active and
harmless agent that can be easily excreted.
 Conversion occurs in the liver through synthetic and
biochemical reaction, although some conversion does
occur in kidney, plasma and intestinal mucosa.
Asma Falak/SON, PIMS 18
Excretion
 The final stage in metabolism takes place when the
drug is changed into inactive form or excreted from
the body.
 Excretion takes place through kidney, lungs, feces,
tears, saliva and mother’s milk
Asma Falak/SON, PIMS 19
Factors effecting drug metabolism
 Personal Attributes such as body weight, age and
gender.
 Physiological factors such as, state of health or
disease process; acid base balance; fluid and
electrolyte balance; permeability; diurnal rhythm and
circulatory capability.
Asma Falak/SON, PIMS 20
Cont..
 Genetic and immunological factors.
 Psychological , emotional and environmental factors
 Drug tolerance
 Drug accumulation
 Responses to the drug vary depending upon the speed of
drug absorption into the blood or tissue and effectiveness
of the circulatory system.
Asma Falak/SON, PIMS 21
Characteristics of a Drug Favoring
Absorption
 Low molecular size
 Nonpolar
 Uncharged
 High lipid solubility
Asma Falak/SON, PIMS 22
Storage of Medications
Asma Falak/SON, PIMS 23
• Medications are dispensed by the pharmacy
to nursing units. Once delivered, proper
storage becomes the responsibility of the
nurse. All medications must be stored in a
cool dry place (usually in cabinets, medicine
carts or fridges)
All medications must be stored in a cool dry place
(usually in cabinets, medicine carts or fridges)
Asma Falak/SON, PIMS 24
Storage of Medications
Asma Falak/SON, PIMS 25
• In less advanced countries, 3 cupboards are
usually used for drug storage.
• Cupboard I-used for drugs for external use
only; e.g. calamine lotion, detol, methylated
spirit etc. These drugs are contained in
distinctive bottles, usually ridged with deep
colours (dark green, blue, brown) with red
label marked POISON and FOR EXTERNAL USE
ONLY.
• Cupboard II-contains drugs for internal use
only e.g. tablets, suspension, mixtures etc. All
drugs must be labeled.
• Cupboard III-contains the dangerous drug;
drugs of addiction. E.g. Morphine, pethedine
etc.
All drugs should be kept away from direct
sunlight and at a temperature suggested by the
manufacturer.
Asma Falak/SON, PIMS 26
• Another cupboard called the Emergency
Cupboard may be stationed at or near the
nurses bay for easy access. This cupboard
contains drugs for emergency situations e.g.
aminophylline (for asthma), hydralazine
(for severe hypertension), oxytocin (for
maternal bleeding), intravenous infusions
(for rehydration) etc.
Asma Falak/SON, PIMS 27
Principles of medication
administration
Asma Falak/SON, PIMS 28
• Principles include 3 checks and 10
Rights:
• 3 checks are
1. Check when obtaining the
container of medicine.
2. Check when removing the
medicine from the container.
3. Check when replacing the
container.
Rights of Medication Administration
Asma Falak/SON, PIMS 29
Medication errors can be detrimental to patients.
To prevent these errors, these guidelines are - the
rights- are used in drug administration.
1. Right Patient: correct identification of the
client cannot be over emphasized. This can be
done by asking the client to mention his/her
full name which should be compared with that
on the identification bracelet or the patient’s
folder and medication/treatment chart for
confirmation.
2. Right Medication
Asma Falak/SON, PIMS 30
 Right Medication: before administering
any medicine, compare name on medication
chart/medication order with that on the
medication at least 3 times-checking medication
label when removing it from storage unit, compare
medication label with that on treatment chart and
medication label and name on treatment chart
with patient’s name tag.
 Beware of same and similar first and surnames
to prevent the error of administering one person’s
medication to another and vice versa.
3. Right Time
Asma Falak/SON, PIMS 31
 Right Time: drug timing is very especially with
some drugs like antibiotics, antimalaria drugs
etc. to achieve cure and prevents resistance.
Some drugs must be given on empty
stomach e.g. antituberculosis drugs; and some
after meals e.g. NSAIDS-these must be noted
and adhered to.
 The interval of administration of drugs should
also be adhered as many drugs that the blood
concentration is not allowed to fall below a given
level and for others two successive doses closer
than prescribed might increase blood
concentration to a dangerous level .
4. Right Dose
Asma Falak/SON, PIMS 32
This becomes very important when
medications at hand are in a larger volume
or strength than the prescribed order given
or when the unit of measurement in the
order is different from that supplied from
the pharmacy. Careful and correct
calculation is important to prevent over or
under dosage of the medication.
5. Right Route
Asma Falak/SON, PIMS 33
An acceptable medication order must
specify the route of medication. If this is
unclear, the prescriber should be contacted
to clarify or specify it. The nurse should
never decide on a route without consulting
the prescriber.
6. Right to information
Asma Falak/SON, PIMS 34
• The patient has the right to know the drug
he/she is taking, desired and adverse effects
and all there is to know about the
medication. The charter on patient’s right
made this clear.
7. Right to Refuse Medication
Asma Falak/SON, PIMS 35
The patient has the right to refuse any
medication. However, the nurse is obliged to
explain to patients why the drug is
prescribed and the consequences refusing
medication.
8. Right Assessment
Asma Falak/SON, PIMS 36
Some medications require specific assessment
before their administration e.g. checking of
vital signs. Before a medication like Digoxin is
administered the pulse must be checked.
Some medication orders may contain specific
assessments to be done prior to medication
9. Right Documentation
Asma Falak/SON, PIMS 37
after
Documentation should be done
medication and not before.
10. Right Evaluation
 Conduct assessment to ascertain drug action,
both desired an side effect.
Asma Falak/SON, PIMS 38
Medication Order
Asma Falak/SON, PIMS 39
The drug order, written by the physician,
should has 7 essential parts for
administration of drugs safely.
1. Patients full name.
2. Date and time.
3. Drug name.
4. Dosage.
5. Route of administration.
6. Time and frequency of administration.
7. Signature of physician.
Types of Medication Orders
Asma Falak/SON, PIMS 40
Four types of medication orders are commonly used:
1. Stat order: A stat order indicates that the
medication is to be given immediately and only
once. e.g: morphine sulfate 10 milligrams IV stat.
2. Single order: The single order or one-time order
indicates that the medication is to be given once
at a specified time. e.g: Seconal 100 milligrams at
bedtime.
3. Standing order: Standing order is written in
advance carried out under specific circumstances.
(e.g: amox twice daily × 2 days).
4. PRN order: “PRN” is a Latin term that stands
for “pro re nata,” which means “as the thing is
needed.” A PRN order or as-needed order,
permits the nurse to give a medication when the
client requires it. (e.g., Amphojel 15 mL prn)
Asma Falak/SON, PIMS 41
Terminologies and
abbreviations used in
prescriptions of medications
Asma Falak/SON, PIMS 42
Abbreviations Meaning
STAT order
 refers to any medication that is needed immediately and is to be
given only once
 often associated with emergency medications that are
needed for life-threatening situations
 comes from the latin word "statim" meaning immediately
 should be administered within 5 minues or less of recieving
the written order
ASAP order
 not as urgent as STAT
 as soon as possible
 should be avaliable for administration to the patient with
30 minutes of the written order
Single order
 for a drug that is to be given only once, and at a specific
time, such as a preoperative order
PRN order
 latin "pro re nata"
 administered as required by the patient's condition
 the nurse makes the judgement, based on
patient assessment, as to when such a
medication is to be administered
Asma Falak/SON, PIMS 43
Abbreviations Meaning
Routine orders
 orders not written as STAT, ASAP, NOW or PRN
 these are usually carried out within 2 hours of the time the
order is written by the physician
Standing order
 written in advance of a situation that is to be carried out under
specific circumstances. example: set of postoperative PRN
prescriptions that are written for all patients who have undergone a
specific surgical procedure "Tylenol elixir 325mg PO every 6 hours
PRN sore throat"
 standing orders are no longer permitted in some facilites because
of the legal implications of putting all patients into a single
treatment category
ac  before meals
AM  morning
bid  twice per day
Cap  capsule
Asma Falak/SON, PIMS 44
Abbreviations Meaning
gtt  drops
h or hr  hours
IM  intramuscular
IV  intravenous
no  number
pc  after meals, after eating
PO  by mouth
PM  afternoon
PRN  when needed/necessary
Asma Falak/SON, PIMS 45
Abbreviations Meaning
qid  four times per day
q2h, q4h, q6h,
q8h, q12h
 every hours
Rx  take
STAT  immediately, at once
tid  three times per day
ad lib  as desired, as directed
tab  tablet
Asma Falak/SON, PIMS 46
Drug forms
Asma Falak/SON, PIMS 47
• Medications are available in variety of
forms. The form of the medication
determines its route of administration.
• Drug forms can be of three
types;
– Solid eg: tablet, capsule
– Liquid eg: syrup, eye drops
– Semi solid eg: ointment, lotion
Asma Falak/SON, PIMS 48
• Tablet: It is the powdered
medication compressed into
hard disk or cylinder.
• Capsule: Medication covered in
gelatin shell.
• Gel or jelly: A clear or
translucent semisolid that
liquefies when applied to the
skin.
Asma Falak/SON, PIMS 49
• Lozenge: A flat, round, or oval
preparation that dissolves and
releases a drug when held in the
mouth.
• Lotion: Drug particles in a solution
for topical use.
• Ointment: Semisolid preparation
containing a drug to be applied
externally.
Asma Falak/SON, PIMS 50
• Powder: Single or mixture of
finely ground drugs.
• Solution: A drug dissolved in
another substance.
• Suspension: Finely divided,
undissolved particles in a liquid
medium; should be shaken
before use.
Asma Falak/SON, PIMS 51
• Syrup: Medication
combined in a water and
sugar solution.
• Suppository: An easily
melted medication
preparation in a firm base
such as gelatin that is
inserted into the body
(rectum, vagina, urethra)
Asma Falak/SON, PIMS 52
• Transdermal patch: Unit dose of
medication applied directly to skin for
diffusion through skin and absorption
into the bloodstream.
Asma Falak/SON, PIMS 53
Asma Falak/SON, PIMS 54
Oral route
Asma Falak/SON, PIMS 55
Oral route: Medications are given
by mouth.
•Buccal Administration:
Administration of a medication by
Placing in the mouth against the
mucous membrane of the cheek until
it dissolves.
Sublingual Administration: Some
medications are readily absorbed
when placed under the tongue to
dissolve.
Parenteral Routes
Asma Falak/SON, PIMS 56
Parenteral Routes : Parenteral
administration involves injecting a
medication into body tissues.
The following are the four major sites of
injection:
1. Intradermal (ID): Injection into the
dermis just under the epidermis.
2. Subcutaneous (SC): Injection into tissues
just below the dermis of the skin.
3. Intramuscular (IM): Injection into a
muscle.
4. Intravenous (IV): Injection into a vein.
Asma Falak/SON, PIMS 57
Injections:
 Epidural: Epidural medications
are administered in the epidural
space.
 Intrathecal: Administration of
medications into subarachnoid
space or one of the ventricles of
the brain.
Asma Falak/SON, PIMS 58
• Intra-articular: Administration of
medication directly into the joints
• Intra-osseous: Administration of
medication directly into the bone marrow.
• Intra-peritoneal:Medications administered
into the peritoneal cavity
• Intra-pleural: Administration of
medications directly into the pleural space.
• Intra-arterial:Intraarterial medications are
administered directly into the arteries.
Asma Falak/SON, PIMS 59
Topical Routes
Asma Falak/SON, PIMS 60
• Topical: Medications applied to the skin and
mucous membranes (eye, ears, nose, mouth,
vagina, urethra, rectum).
• Inhalation Route: Administer inhaled
medications through the nasal and oral
passages or endotracheal or tracheostomy
tubes.
Asma Falak/SON, PIMS 61
Broad Classification of drugs
Asma Falak/SON, PIMS 62
A drug may be classified by the chemical type of
active ingredient or by the way it is used to
treat a particular condition. Eg:
• Analgesics: to reduce pain
• Antipyretics: to reduce fever
• Antibiotics: to treat bacterial infection
• Anti viral: to treat viral infection
• Antihypertensive : to treat hypertension
• Antidiabetic: to treat diabetes
Types of Medication Action/Effects
Asma Falak/SON, PIMS 63
• Therapeutic Effects
• Side Effects/Adverse Effects
• Toxic Effects
• Allergic Reactions
• Idiosyncratic Reactions
• Therapeutic Effects: The therapeutic effect is the
expected or predicted physiological response that a
medication causes.
-Eg: paracetamol reduces pain, fever and inflammation
• Side Effects/Adverse Effects: Every medication
cause some harm to patient.
– Side effects are predictable and often unavoidable
secondary effects produced at a usual therapeutic dose.
– Eg: nausea, loss of appetite, stomach pain
– Adverse effects are undesirable and unpredictable severe
responses to medication.
Asma Falak/SON, PIMS 64
• Toxic Effects: Toxic effects develop after
prolonged intake of a medication or when a
medication accumulates in the blood because of
impaired metabolism or excretion.
Eg: liver damage or kidney damage
•Adverse effects: An adverse drug reaction (ADR) can be
defined as 'an appreciably harmful or unpleasant
reaction resulting from an intervention related to the use
of a medicinal product; adverse effects usually predict
hazard from future administration and warrant prevention,
or specific treatment, or alteration of the dosage regimen
Asma Falak/SON, PIMS 65
• Allergic Reactions: unpredictable
immunological responses to a medication.
Eg: paracetamol produces rash or swelling as
allergic reaction.
• Idiosyncratic Reactions: a patient
overreacts or underreacts to a medication or
has a reaction different from normal.
For example, a child who receives Benadryl
becomes extremely agitated or excited instead of
drowsy.
Asma Falak/SON, PIMS 66
Drug Interaction
 A drug interaction is a change in the action or
side effects of a drug caused by concomitant
administration with a food, beverage,
supplement, or another drug. A cause of a drug
interaction involves one drug which alters the
pharmacokinetics of another medical drug.
Asma Falak/SON, PIMS 67
Systems of drug measurement
Asma Falak/SON, PIMS 68
Different systems available are;
• Metric system
• Household system
• Apothecary system
• Solutions
• Metric system : In this system, metric units
are used. Eg: milligram, gram, milliliter, liter
etc
• Household system: Household measures
include drops, teaspoons, tablespoons or cups
for measuring medications. Their
disadvantage is their inaccuracy. Household
utensils such as teaspoons and cups vary in
size.
Asma Falak/SON, PIMS 69
• Eg:
Metric system Household system
1 ml 15 drops
5 ml 1 teaspoon
15 ml 1 tablespoon
Asma Falak/SON, PIMS 70
• Apothecary system : It is older system. The
basic unit of weight in the apothecary
system is the grain (gr) and the basic unit of
volume is the minim.
The other units of weight are the dram,
the ounce, and the pound. The units of volume
are the fluid dram, the fluid ounce, the pint,
the quart, and the gallon.
Asma Falak/SON, PIMS 71
• Eg:
Metric system Apothecary system
1 mg 1/60 grain
60 mg 1 grain
1 g 15 grains
4 g 1 dram
30 g 1 ounce
500 g 1.1 pound (lb)
1 ml 15-16 minims
5 ml 1 fluid dram
30 ml 1 fluid ounce
500 ml 1 pint
1 L 1 quart
4 L 1 gallon
Asma Falak/SON, PIMS 72
• Solutions: A solution is a given mass of
solid substance dissolved in a known
volume of fluid or a given volume of liquid
dissolved in a known volume of another
fluid.
For example, a 10% solution is 10 g of solid
dissolved in 100 mL of solution.
Asma Falak/SON, PIMS 73
Converting Measurements Units
Asma Falak/SON, PIMS 74
• Conversion within one system
• Conversion between systems
• Dosage Calculation
Conversion within one system
 • To convert measurements within one system
simply divide or multiply.
 • Eg: To change milligrams to grams, divide by
1000, moving the decimal 3 points to the left.
Asma Falak/SON, PIMS 75
1000 mg
350 mg
= 1 g
= 0.35 g
Conversion Between Systems
Asma Falak/SON, PIMS 76
• To convert measurements from one system
to another system the nurse should be
familiar with the equivalent values of all the
systems.
Asma Falak/SON, PIMS 77
Dose Calculations
Asma Falak/SON, PIMS 78
Methods used to calculate medication doses
include
• The ratio and proportion method
• The formula method
• Dimensional analysis
• The Ratio and Proportion Method: A ratio
indicates the relationship between two
numbers separated by a colon (:). For
example, the ratio 1 : 2 is the same as 1/2.
Write a proportion in one of three ways:
Example 1: 1:2 = 4:8
Example 2: 1:2 :: 4:8
Example 3: 1/2 = 4/8
Asma Falak/SON, PIMS 79
In a proportion the first and last
numbers are called the extremes, and the
second and third numbers are called the
means. When multiplying the extremes, the
answer is the same when multiplying the
means.
Example: The prescriber orders 500 mg of
amoxicillin to be administered in every 8
hours. The bottle of amoxicillin is labeled 400
mg/5 mL.
Asma Falak/SON, PIMS 80
Formula Method
Asma Falak/SON, PIMS 81
1. Calculating dose of solid medications
First convert the drug amount to the same units
and then use the formula.
𝒔𝒕𝒐𝒄𝒌 𝒔𝒕𝒓𝒆𝒏𝒈𝒕𝒉
Dose required= 𝒔𝒕𝒓𝒆𝒏𝒈𝒕𝒉 𝒓𝒆𝒒𝒖𝒊𝒓𝒆𝒅
= number of
tablets
on the
Stock strength is the amount written
drug cover.
2. Calculating dose of liquid medications First
convert the drug amount to the same units and
then use the formula
Asma Falak/SON, PIMS 82
Volume required=
𝑠𝑡𝑟𝑒𝑛𝑔𝑡ℎ 𝑟𝑒𝑞𝑢𝑖𝑟𝑒𝑑×𝑣𝑜𝑙𝑢𝑚𝑒 𝑜𝑓 𝑠𝑡𝑜𝑐𝑘 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛/𝑠𝑡𝑜𝑐𝑘 𝑠𝑡𝑟𝑒𝑛𝑔𝑡ℎ
3. Calculating drip Rates
Asma Falak/SON, PIMS 83
First convert volume to milliliters and then
use this formula
drops per 𝑚𝑖𝑛𝑢𝑡𝑒 =
𝑡𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑡𝑜 𝑏𝑒 𝑔𝑖𝑣𝑒𝑛 ×𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟
𝑡𝑖𝑚𝑒 𝑖𝑛 ℎ𝑜𝑢𝑟𝑠 × 60
Drop factor is the drops per millilitre given to
the patient.
Drop factor for macro set is 15 and micro set
is 60
Asma Falak/SON, PIMS 84
4. Calculating dose according to body
weight
Total dose = prescribed dose x patient’s
weight
5. Calculating dose according to body
surface area
Total dose = prescribed dose x patient’s body
surface area
Asma Falak/SON, PIMS 85
Factors affecting drug action
Asma Falak/SON, PIMS 86
• Body Size
• Pregnancy
• Lactation
• Age – Peadiatric & Geriatric
• Genetic Factors
• Disease States – Kidney & Liver
• Routes of Drug Administration
• Environmental Factors
• Psychological Factors
• Tolerance & Resistance
Factors affecting medication action
 Various factors affects the action of the
medicine.
1. Developmental Factors
 a. Pregnancy : Most drugs are contraindicated
because of their possible adverse effects on the
fetus.
 b. Infants usually require small dosages because of
their body size and the immaturity of their organs.
Asma Falak/SON, PIMS 87
c. In adolescence or adulthood, allergic
reactions may occur.
d. Oldage have different responses
to medications due to aging.
2. Gender
Different action can occur in men and
women due to the distribution of body fat and
fluid and hormonal differences.
Asma Falak/SON, PIMS 88
3. Cultural, Ethnic, and Genetic Factors
• Genetic differences in the production of
enzymes that affect drug metabolism. Cultural
factors and practices (e.g., values and beliefs)
can also affect a drug’s action.
4. Diet
• Nutrients can affect the action of a
medication. For example,vitamin K, found in
green leafy vegetables, can counteract the
effect of an anticoagulant such as warfarin
Asma Falak/SON, PIMS 89
5. Environment
• Environmental temperature may also affect
drug activity. When environmental
temperature is high, the peripheral blood
vessels dilate, thus increase the action of
vasodilators.
• A client who takes a sedative or analgesic in
a busy, noisy environment may not benefit
as fully as if the environment were quiet and
peaceful.
Asma Falak/SON, PIMS 90
6. Psychological Factors
A client’s expectations about what a drug
can do can affect the response to the
medication.
7. Illness and Disease
Drug action is altered in clients with
circulatory, liver, or kidney dysfunction.
8. Time of Administration
• The time of administration of oral
medications affects the speed with which
they act.
Asma Falak/SON, PIMS 91
Safety in Administering Medications
 The safe and accurate administration of
medication is one of the major responsibility of a
nurse.
 Read the physician’s orders of the drug.
 If the order is not clear consult the physician.
 Consider the age and weight of the patient.
Asma Falak/SON, PIMS 92
Cont…
 The nurse must have thorough knowledge of
drugs that is administered by her.
 Look for the colour, odour and consistency of the
drug before administration.
 Follow 10 rights and 3 checks in drug
administration.
Asma Falak/SON, PIMS 93
• Calculate the drug dosage accurately.
• Identify the patient correctly.
• Observe for the symptoms of over dosage of
the drugs before it is administered.
• Give the drugs one by one
• Stay with the patient until he has taken the
medicine completely.
• Do not leave the medicine with the patient.
Asma Falak/SON, PIMS 94
• The nurse should always assess a client’s
health status and obtain a medication
history prior to giving any medication.
• The medication history includes
information about the drugs the client is
taking currently or has taken recently. And
the history of drug allergies.
• The nurse should clarify with the client any
side effects, adverse reactions, or allergic
responses due to medications.
Asma Falak/SON, PIMS 95
• The nurse has to identify any problems the
client may have in self-administering a
medication.
• For example, a client with poor eyesight,
may require special labels for the
medication container.
• The nurse needs to consider socioeconomic
factors for all clients.
• Medication errors must be reported
according to the policy of the hospital.
Asma Falak/SON, PIMS 96
Medication Error
Asma Falak/SON, PIMS 97
• Medication errors are unintended
mistakes in the prescribing, dispensing and
administration of a medicine that could
cause harm to a patient.
• Medication errors can occur at all stages of the
medication administration process.
• The four main types of medication errors that occur
with hospitalized clients:
1. Prescription errors (eg. Wrong drug or dose)
2. Transcription/ interpretation error (eg.
Misinterpretation of abbreviations)
3. Preparation errors (eg. Calculation error)
4. Administration errors (eg. Wrong
dose, wrong time, omission,
or additional dose).
Most medication errors occur during the
administration stage.
Asma Falak/SON, PIMS 98
Asma Falak/SON, PIMS 99

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Drug Administration Part-I .pptx

  • 1. DRUG ADMINISTARTION ASMA FALAK MSN(Silver Medal), PRN,CCN(Silver Medal),RM,RN Nursing Instructor School of Nursing & Midwifery PIMS, Islamabad Asma Falak/SON, PIMS 1
  • 2. • A medication is a substance administered for the diagnosis, cure, treatment, or relief of a symptom or for prevention of disease. • Pharmacology is the study of the effect of drugs on living organisms. • Prodrug: Asma Falak/SON, PIMS 2
  • 3. • The written direction for the preparation and administration of a drug is called a prescription. Asma Falak/SON, PIMS 3
  • 4. Purpose of Medication Asma Falak/SON, PIMS 4 Drugs can be administered for these purposes: • Diagnostic purpose: To identify any disease • Prophylaxis: To prevent the occurrence of the disease e.g. heparin to prevent thrombosis or antibiotic to prevent infection. • Therapeutic Purpose: To cure the disease.
  • 5. Uses of Drugs Asma Falak/SON, PIMS 5 ⚫ Prevention- used as prophylaxis to prevent diseases e.g. vaccines; fluoride-prevents tooth decay. ⚫Diagnosis- establishing the patient’s disease or problem e.g. radio contrast dye; tuberculosis (Mantoux) testing. ⚫Suppression- suppresses the signs and symptoms and prevents the disease process from progressing e.g. anticancer, antiviral drugs.
  • 6. ⚫Treatment- alleviate the symptoms for patients with chronic disease e.g. Anti- asthmatic drugs. ⚫Cure- complete eradication of diseases e.g. anti-biotics, anti-helmintics. ⚫Enhancement aspects of health- achieve the best state of health e.g. vitamins, minerals. Asma Falak/SON, PIMS 6
  • 7. Legal Aspects of Medication Asma Falak/SON, PIMS 7 ⚫ Preparation, dispensing and administration of medications are all covered by laws in every country. ⚫ Dangerous drugs are always kept under lock and key in the Dangerous Drug Cupboard under the care of trusted senior nurses.
  • 8.  Dangerous Drug Act – 1930 and The Narcotic Drugs and Psychotropic Substances Act - 1985. It is an act that governs the procurement and use of some drugs especially the narcotics e.g. morphine, pethedine, cocaine etc. These drugs are prescription only drugs hence cannot be bought or administered without prescription. Asma Falak/SON, PIMS 8
  • 9. ⚫It is worth knowing that nurses are responsible for their own actions regardless of the presence of a written order. If a nurse gives an overdose of a drug because it is written by a doctor, the error is accounted to the nurse and not the doctor. The nurse should bear in mind that ALL substances are poisons: there is none that is not a poison. The right dose differentiates a poison from a remedy. Asma Falak/SON, PIMS 9
  • 10. Drug Nomenclature Asma Falak/SON, PIMS 10 One drug can have as much as 4 different names as follows: ⚫Chemical Name - any typical organic name; this precisely describes the constituents of the drug ⚫E.g. N-(4-hydroxyphenyl)acetamide for paracetamol
  • 11. • Generic Name - is given by the manufacturer who first develops the drug; it is given before the drug becomes official. It is the name by which the drug will be known throughout the world no matter how many companies manufacture it. This name is usually agreed upon by the WHO. Often the generic name is derived from the chemical name. E.g. acetaminophen Asma Falak/SON, PIMS 11
  • 12. • Official Name – United States Adopted Name (USAN) or Japanese Accepted Name (JAN). It will also apply for an International Nonproprietary Name (INN) through the World Health Organization (WHO). Trade Name: Asma Falak/SON, PIMS 12
  • 13. Classification of Medication Asma Falak/SON, PIMS 13 Medications may be classified according to: ⚫ The body system that the medicine is targeted to interacts wit; e.g. cardiovascular medications, nervous system medication etc. ⚫ Therapeutic usages of the medicine; e.g. antihypertensives ,neuroleptics, ⚫The diseases the medicine is used for; e. g. anticancer drugs, antimalaria drugs antihelminthics etc.
  • 14. • The action of the medication can also be used to classify the it; e.g. beta-adrenergic blocking agents • The overall effect of the medication on the body can also be a criteria for its classification; e.g. sedatives, antianxiety drugs etc. Asma Falak/SON, PIMS 14
  • 15. Drug Metabolism  Drug Metabolism in human body is accomplished in four basic stages; I. Absorption II. Transportation III. Biotransformation IV. Excretion Asma Falak/SON, PIMS 15
  • 16. Absorption  The process by which the drug moves into the body from external source until it is absorbed in the circulation.  Drugs are absorbed through; mucous membrane, gastrointestinal, respiratory tract and skin.  Absorption depends on the PH of the stomach, contents of food and presence of disease.  IV is the fastest route for drug absorption. Asma Falak/SON, PIMS 16
  • 17. Transportation  The way in which a drug is transported from the site of introduction to the site of action.  It binds to a specific plasma protein in the blood and transported to the body parts.  It depends upon the permeability of the membranes and the blood supply to the absorption area. Asma Falak/SON, PIMS 17
  • 18. Biotransformation  Drug is converted by enzymes into a less active and harmless agent that can be easily excreted.  Conversion occurs in the liver through synthetic and biochemical reaction, although some conversion does occur in kidney, plasma and intestinal mucosa. Asma Falak/SON, PIMS 18
  • 19. Excretion  The final stage in metabolism takes place when the drug is changed into inactive form or excreted from the body.  Excretion takes place through kidney, lungs, feces, tears, saliva and mother’s milk Asma Falak/SON, PIMS 19
  • 20. Factors effecting drug metabolism  Personal Attributes such as body weight, age and gender.  Physiological factors such as, state of health or disease process; acid base balance; fluid and electrolyte balance; permeability; diurnal rhythm and circulatory capability. Asma Falak/SON, PIMS 20
  • 21. Cont..  Genetic and immunological factors.  Psychological , emotional and environmental factors  Drug tolerance  Drug accumulation  Responses to the drug vary depending upon the speed of drug absorption into the blood or tissue and effectiveness of the circulatory system. Asma Falak/SON, PIMS 21
  • 22. Characteristics of a Drug Favoring Absorption  Low molecular size  Nonpolar  Uncharged  High lipid solubility Asma Falak/SON, PIMS 22
  • 23. Storage of Medications Asma Falak/SON, PIMS 23 • Medications are dispensed by the pharmacy to nursing units. Once delivered, proper storage becomes the responsibility of the nurse. All medications must be stored in a cool dry place (usually in cabinets, medicine carts or fridges)
  • 24. All medications must be stored in a cool dry place (usually in cabinets, medicine carts or fridges) Asma Falak/SON, PIMS 24
  • 25. Storage of Medications Asma Falak/SON, PIMS 25 • In less advanced countries, 3 cupboards are usually used for drug storage. • Cupboard I-used for drugs for external use only; e.g. calamine lotion, detol, methylated spirit etc. These drugs are contained in distinctive bottles, usually ridged with deep colours (dark green, blue, brown) with red label marked POISON and FOR EXTERNAL USE ONLY.
  • 26. • Cupboard II-contains drugs for internal use only e.g. tablets, suspension, mixtures etc. All drugs must be labeled. • Cupboard III-contains the dangerous drug; drugs of addiction. E.g. Morphine, pethedine etc. All drugs should be kept away from direct sunlight and at a temperature suggested by the manufacturer. Asma Falak/SON, PIMS 26
  • 27. • Another cupboard called the Emergency Cupboard may be stationed at or near the nurses bay for easy access. This cupboard contains drugs for emergency situations e.g. aminophylline (for asthma), hydralazine (for severe hypertension), oxytocin (for maternal bleeding), intravenous infusions (for rehydration) etc. Asma Falak/SON, PIMS 27
  • 28. Principles of medication administration Asma Falak/SON, PIMS 28 • Principles include 3 checks and 10 Rights: • 3 checks are 1. Check when obtaining the container of medicine. 2. Check when removing the medicine from the container. 3. Check when replacing the container.
  • 29. Rights of Medication Administration Asma Falak/SON, PIMS 29 Medication errors can be detrimental to patients. To prevent these errors, these guidelines are - the rights- are used in drug administration. 1. Right Patient: correct identification of the client cannot be over emphasized. This can be done by asking the client to mention his/her full name which should be compared with that on the identification bracelet or the patient’s folder and medication/treatment chart for confirmation.
  • 30. 2. Right Medication Asma Falak/SON, PIMS 30  Right Medication: before administering any medicine, compare name on medication chart/medication order with that on the medication at least 3 times-checking medication label when removing it from storage unit, compare medication label with that on treatment chart and medication label and name on treatment chart with patient’s name tag.  Beware of same and similar first and surnames to prevent the error of administering one person’s medication to another and vice versa.
  • 31. 3. Right Time Asma Falak/SON, PIMS 31  Right Time: drug timing is very especially with some drugs like antibiotics, antimalaria drugs etc. to achieve cure and prevents resistance. Some drugs must be given on empty stomach e.g. antituberculosis drugs; and some after meals e.g. NSAIDS-these must be noted and adhered to.  The interval of administration of drugs should also be adhered as many drugs that the blood concentration is not allowed to fall below a given level and for others two successive doses closer than prescribed might increase blood concentration to a dangerous level .
  • 32. 4. Right Dose Asma Falak/SON, PIMS 32 This becomes very important when medications at hand are in a larger volume or strength than the prescribed order given or when the unit of measurement in the order is different from that supplied from the pharmacy. Careful and correct calculation is important to prevent over or under dosage of the medication.
  • 33. 5. Right Route Asma Falak/SON, PIMS 33 An acceptable medication order must specify the route of medication. If this is unclear, the prescriber should be contacted to clarify or specify it. The nurse should never decide on a route without consulting the prescriber.
  • 34. 6. Right to information Asma Falak/SON, PIMS 34 • The patient has the right to know the drug he/she is taking, desired and adverse effects and all there is to know about the medication. The charter on patient’s right made this clear.
  • 35. 7. Right to Refuse Medication Asma Falak/SON, PIMS 35 The patient has the right to refuse any medication. However, the nurse is obliged to explain to patients why the drug is prescribed and the consequences refusing medication.
  • 36. 8. Right Assessment Asma Falak/SON, PIMS 36 Some medications require specific assessment before their administration e.g. checking of vital signs. Before a medication like Digoxin is administered the pulse must be checked. Some medication orders may contain specific assessments to be done prior to medication
  • 37. 9. Right Documentation Asma Falak/SON, PIMS 37 after Documentation should be done medication and not before.
  • 38. 10. Right Evaluation  Conduct assessment to ascertain drug action, both desired an side effect. Asma Falak/SON, PIMS 38
  • 39. Medication Order Asma Falak/SON, PIMS 39 The drug order, written by the physician, should has 7 essential parts for administration of drugs safely. 1. Patients full name. 2. Date and time. 3. Drug name. 4. Dosage. 5. Route of administration. 6. Time and frequency of administration. 7. Signature of physician.
  • 40. Types of Medication Orders Asma Falak/SON, PIMS 40 Four types of medication orders are commonly used: 1. Stat order: A stat order indicates that the medication is to be given immediately and only once. e.g: morphine sulfate 10 milligrams IV stat. 2. Single order: The single order or one-time order indicates that the medication is to be given once at a specified time. e.g: Seconal 100 milligrams at bedtime.
  • 41. 3. Standing order: Standing order is written in advance carried out under specific circumstances. (e.g: amox twice daily × 2 days). 4. PRN order: “PRN” is a Latin term that stands for “pro re nata,” which means “as the thing is needed.” A PRN order or as-needed order, permits the nurse to give a medication when the client requires it. (e.g., Amphojel 15 mL prn) Asma Falak/SON, PIMS 41
  • 42. Terminologies and abbreviations used in prescriptions of medications Asma Falak/SON, PIMS 42
  • 43. Abbreviations Meaning STAT order  refers to any medication that is needed immediately and is to be given only once  often associated with emergency medications that are needed for life-threatening situations  comes from the latin word "statim" meaning immediately  should be administered within 5 minues or less of recieving the written order ASAP order  not as urgent as STAT  as soon as possible  should be avaliable for administration to the patient with 30 minutes of the written order Single order  for a drug that is to be given only once, and at a specific time, such as a preoperative order PRN order  latin "pro re nata"  administered as required by the patient's condition  the nurse makes the judgement, based on patient assessment, as to when such a medication is to be administered Asma Falak/SON, PIMS 43
  • 44. Abbreviations Meaning Routine orders  orders not written as STAT, ASAP, NOW or PRN  these are usually carried out within 2 hours of the time the order is written by the physician Standing order  written in advance of a situation that is to be carried out under specific circumstances. example: set of postoperative PRN prescriptions that are written for all patients who have undergone a specific surgical procedure "Tylenol elixir 325mg PO every 6 hours PRN sore throat"  standing orders are no longer permitted in some facilites because of the legal implications of putting all patients into a single treatment category ac  before meals AM  morning bid  twice per day Cap  capsule Asma Falak/SON, PIMS 44
  • 45. Abbreviations Meaning gtt  drops h or hr  hours IM  intramuscular IV  intravenous no  number pc  after meals, after eating PO  by mouth PM  afternoon PRN  when needed/necessary Asma Falak/SON, PIMS 45
  • 46. Abbreviations Meaning qid  four times per day q2h, q4h, q6h, q8h, q12h  every hours Rx  take STAT  immediately, at once tid  three times per day ad lib  as desired, as directed tab  tablet Asma Falak/SON, PIMS 46
  • 47. Drug forms Asma Falak/SON, PIMS 47 • Medications are available in variety of forms. The form of the medication determines its route of administration.
  • 48. • Drug forms can be of three types; – Solid eg: tablet, capsule – Liquid eg: syrup, eye drops – Semi solid eg: ointment, lotion Asma Falak/SON, PIMS 48
  • 49. • Tablet: It is the powdered medication compressed into hard disk or cylinder. • Capsule: Medication covered in gelatin shell. • Gel or jelly: A clear or translucent semisolid that liquefies when applied to the skin. Asma Falak/SON, PIMS 49
  • 50. • Lozenge: A flat, round, or oval preparation that dissolves and releases a drug when held in the mouth. • Lotion: Drug particles in a solution for topical use. • Ointment: Semisolid preparation containing a drug to be applied externally. Asma Falak/SON, PIMS 50
  • 51. • Powder: Single or mixture of finely ground drugs. • Solution: A drug dissolved in another substance. • Suspension: Finely divided, undissolved particles in a liquid medium; should be shaken before use. Asma Falak/SON, PIMS 51
  • 52. • Syrup: Medication combined in a water and sugar solution. • Suppository: An easily melted medication preparation in a firm base such as gelatin that is inserted into the body (rectum, vagina, urethra) Asma Falak/SON, PIMS 52
  • 53. • Transdermal patch: Unit dose of medication applied directly to skin for diffusion through skin and absorption into the bloodstream. Asma Falak/SON, PIMS 53
  • 55. Oral route Asma Falak/SON, PIMS 55 Oral route: Medications are given by mouth. •Buccal Administration: Administration of a medication by Placing in the mouth against the mucous membrane of the cheek until it dissolves. Sublingual Administration: Some medications are readily absorbed when placed under the tongue to dissolve.
  • 56. Parenteral Routes Asma Falak/SON, PIMS 56 Parenteral Routes : Parenteral administration involves injecting a medication into body tissues. The following are the four major sites of injection: 1. Intradermal (ID): Injection into the dermis just under the epidermis. 2. Subcutaneous (SC): Injection into tissues just below the dermis of the skin. 3. Intramuscular (IM): Injection into a muscle. 4. Intravenous (IV): Injection into a vein.
  • 58. Injections:  Epidural: Epidural medications are administered in the epidural space.  Intrathecal: Administration of medications into subarachnoid space or one of the ventricles of the brain. Asma Falak/SON, PIMS 58
  • 59. • Intra-articular: Administration of medication directly into the joints • Intra-osseous: Administration of medication directly into the bone marrow. • Intra-peritoneal:Medications administered into the peritoneal cavity • Intra-pleural: Administration of medications directly into the pleural space. • Intra-arterial:Intraarterial medications are administered directly into the arteries. Asma Falak/SON, PIMS 59
  • 60. Topical Routes Asma Falak/SON, PIMS 60 • Topical: Medications applied to the skin and mucous membranes (eye, ears, nose, mouth, vagina, urethra, rectum).
  • 61. • Inhalation Route: Administer inhaled medications through the nasal and oral passages or endotracheal or tracheostomy tubes. Asma Falak/SON, PIMS 61
  • 62. Broad Classification of drugs Asma Falak/SON, PIMS 62 A drug may be classified by the chemical type of active ingredient or by the way it is used to treat a particular condition. Eg: • Analgesics: to reduce pain • Antipyretics: to reduce fever • Antibiotics: to treat bacterial infection • Anti viral: to treat viral infection • Antihypertensive : to treat hypertension • Antidiabetic: to treat diabetes
  • 63. Types of Medication Action/Effects Asma Falak/SON, PIMS 63 • Therapeutic Effects • Side Effects/Adverse Effects • Toxic Effects • Allergic Reactions • Idiosyncratic Reactions
  • 64. • Therapeutic Effects: The therapeutic effect is the expected or predicted physiological response that a medication causes. -Eg: paracetamol reduces pain, fever and inflammation • Side Effects/Adverse Effects: Every medication cause some harm to patient. – Side effects are predictable and often unavoidable secondary effects produced at a usual therapeutic dose. – Eg: nausea, loss of appetite, stomach pain – Adverse effects are undesirable and unpredictable severe responses to medication. Asma Falak/SON, PIMS 64
  • 65. • Toxic Effects: Toxic effects develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion. Eg: liver damage or kidney damage •Adverse effects: An adverse drug reaction (ADR) can be defined as 'an appreciably harmful or unpleasant reaction resulting from an intervention related to the use of a medicinal product; adverse effects usually predict hazard from future administration and warrant prevention, or specific treatment, or alteration of the dosage regimen Asma Falak/SON, PIMS 65
  • 66. • Allergic Reactions: unpredictable immunological responses to a medication. Eg: paracetamol produces rash or swelling as allergic reaction. • Idiosyncratic Reactions: a patient overreacts or underreacts to a medication or has a reaction different from normal. For example, a child who receives Benadryl becomes extremely agitated or excited instead of drowsy. Asma Falak/SON, PIMS 66
  • 67. Drug Interaction  A drug interaction is a change in the action or side effects of a drug caused by concomitant administration with a food, beverage, supplement, or another drug. A cause of a drug interaction involves one drug which alters the pharmacokinetics of another medical drug. Asma Falak/SON, PIMS 67
  • 68. Systems of drug measurement Asma Falak/SON, PIMS 68 Different systems available are; • Metric system • Household system • Apothecary system • Solutions
  • 69. • Metric system : In this system, metric units are used. Eg: milligram, gram, milliliter, liter etc • Household system: Household measures include drops, teaspoons, tablespoons or cups for measuring medications. Their disadvantage is their inaccuracy. Household utensils such as teaspoons and cups vary in size. Asma Falak/SON, PIMS 69
  • 70. • Eg: Metric system Household system 1 ml 15 drops 5 ml 1 teaspoon 15 ml 1 tablespoon Asma Falak/SON, PIMS 70
  • 71. • Apothecary system : It is older system. The basic unit of weight in the apothecary system is the grain (gr) and the basic unit of volume is the minim. The other units of weight are the dram, the ounce, and the pound. The units of volume are the fluid dram, the fluid ounce, the pint, the quart, and the gallon. Asma Falak/SON, PIMS 71
  • 72. • Eg: Metric system Apothecary system 1 mg 1/60 grain 60 mg 1 grain 1 g 15 grains 4 g 1 dram 30 g 1 ounce 500 g 1.1 pound (lb) 1 ml 15-16 minims 5 ml 1 fluid dram 30 ml 1 fluid ounce 500 ml 1 pint 1 L 1 quart 4 L 1 gallon Asma Falak/SON, PIMS 72
  • 73. • Solutions: A solution is a given mass of solid substance dissolved in a known volume of fluid or a given volume of liquid dissolved in a known volume of another fluid. For example, a 10% solution is 10 g of solid dissolved in 100 mL of solution. Asma Falak/SON, PIMS 73
  • 74. Converting Measurements Units Asma Falak/SON, PIMS 74 • Conversion within one system • Conversion between systems • Dosage Calculation
  • 75. Conversion within one system  • To convert measurements within one system simply divide or multiply.  • Eg: To change milligrams to grams, divide by 1000, moving the decimal 3 points to the left. Asma Falak/SON, PIMS 75 1000 mg 350 mg = 1 g = 0.35 g
  • 76. Conversion Between Systems Asma Falak/SON, PIMS 76 • To convert measurements from one system to another system the nurse should be familiar with the equivalent values of all the systems.
  • 78. Dose Calculations Asma Falak/SON, PIMS 78 Methods used to calculate medication doses include • The ratio and proportion method • The formula method • Dimensional analysis
  • 79. • The Ratio and Proportion Method: A ratio indicates the relationship between two numbers separated by a colon (:). For example, the ratio 1 : 2 is the same as 1/2. Write a proportion in one of three ways: Example 1: 1:2 = 4:8 Example 2: 1:2 :: 4:8 Example 3: 1/2 = 4/8 Asma Falak/SON, PIMS 79
  • 80. In a proportion the first and last numbers are called the extremes, and the second and third numbers are called the means. When multiplying the extremes, the answer is the same when multiplying the means. Example: The prescriber orders 500 mg of amoxicillin to be administered in every 8 hours. The bottle of amoxicillin is labeled 400 mg/5 mL. Asma Falak/SON, PIMS 80
  • 81. Formula Method Asma Falak/SON, PIMS 81 1. Calculating dose of solid medications First convert the drug amount to the same units and then use the formula. 𝒔𝒕𝒐𝒄𝒌 𝒔𝒕𝒓𝒆𝒏𝒈𝒕𝒉 Dose required= 𝒔𝒕𝒓𝒆𝒏𝒈𝒕𝒉 𝒓𝒆𝒒𝒖𝒊𝒓𝒆𝒅 = number of tablets on the Stock strength is the amount written drug cover.
  • 82. 2. Calculating dose of liquid medications First convert the drug amount to the same units and then use the formula Asma Falak/SON, PIMS 82 Volume required= 𝑠𝑡𝑟𝑒𝑛𝑔𝑡ℎ 𝑟𝑒𝑞𝑢𝑖𝑟𝑒𝑑×𝑣𝑜𝑙𝑢𝑚𝑒 𝑜𝑓 𝑠𝑡𝑜𝑐𝑘 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛/𝑠𝑡𝑜𝑐𝑘 𝑠𝑡𝑟𝑒𝑛𝑔𝑡ℎ
  • 83. 3. Calculating drip Rates Asma Falak/SON, PIMS 83 First convert volume to milliliters and then use this formula drops per 𝑚𝑖𝑛𝑢𝑡𝑒 = 𝑡𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑡𝑜 𝑏𝑒 𝑔𝑖𝑣𝑒𝑛 ×𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟 𝑡𝑖𝑚𝑒 𝑖𝑛 ℎ𝑜𝑢𝑟𝑠 × 60 Drop factor is the drops per millilitre given to the patient. Drop factor for macro set is 15 and micro set is 60
  • 85. 4. Calculating dose according to body weight Total dose = prescribed dose x patient’s weight 5. Calculating dose according to body surface area Total dose = prescribed dose x patient’s body surface area Asma Falak/SON, PIMS 85
  • 86. Factors affecting drug action Asma Falak/SON, PIMS 86 • Body Size • Pregnancy • Lactation • Age – Peadiatric & Geriatric • Genetic Factors • Disease States – Kidney & Liver • Routes of Drug Administration • Environmental Factors • Psychological Factors • Tolerance & Resistance
  • 87. Factors affecting medication action  Various factors affects the action of the medicine. 1. Developmental Factors  a. Pregnancy : Most drugs are contraindicated because of their possible adverse effects on the fetus.  b. Infants usually require small dosages because of their body size and the immaturity of their organs. Asma Falak/SON, PIMS 87
  • 88. c. In adolescence or adulthood, allergic reactions may occur. d. Oldage have different responses to medications due to aging. 2. Gender Different action can occur in men and women due to the distribution of body fat and fluid and hormonal differences. Asma Falak/SON, PIMS 88
  • 89. 3. Cultural, Ethnic, and Genetic Factors • Genetic differences in the production of enzymes that affect drug metabolism. Cultural factors and practices (e.g., values and beliefs) can also affect a drug’s action. 4. Diet • Nutrients can affect the action of a medication. For example,vitamin K, found in green leafy vegetables, can counteract the effect of an anticoagulant such as warfarin Asma Falak/SON, PIMS 89
  • 90. 5. Environment • Environmental temperature may also affect drug activity. When environmental temperature is high, the peripheral blood vessels dilate, thus increase the action of vasodilators. • A client who takes a sedative or analgesic in a busy, noisy environment may not benefit as fully as if the environment were quiet and peaceful. Asma Falak/SON, PIMS 90
  • 91. 6. Psychological Factors A client’s expectations about what a drug can do can affect the response to the medication. 7. Illness and Disease Drug action is altered in clients with circulatory, liver, or kidney dysfunction. 8. Time of Administration • The time of administration of oral medications affects the speed with which they act. Asma Falak/SON, PIMS 91
  • 92. Safety in Administering Medications  The safe and accurate administration of medication is one of the major responsibility of a nurse.  Read the physician’s orders of the drug.  If the order is not clear consult the physician.  Consider the age and weight of the patient. Asma Falak/SON, PIMS 92
  • 93. Cont…  The nurse must have thorough knowledge of drugs that is administered by her.  Look for the colour, odour and consistency of the drug before administration.  Follow 10 rights and 3 checks in drug administration. Asma Falak/SON, PIMS 93
  • 94. • Calculate the drug dosage accurately. • Identify the patient correctly. • Observe for the symptoms of over dosage of the drugs before it is administered. • Give the drugs one by one • Stay with the patient until he has taken the medicine completely. • Do not leave the medicine with the patient. Asma Falak/SON, PIMS 94
  • 95. • The nurse should always assess a client’s health status and obtain a medication history prior to giving any medication. • The medication history includes information about the drugs the client is taking currently or has taken recently. And the history of drug allergies. • The nurse should clarify with the client any side effects, adverse reactions, or allergic responses due to medications. Asma Falak/SON, PIMS 95
  • 96. • The nurse has to identify any problems the client may have in self-administering a medication. • For example, a client with poor eyesight, may require special labels for the medication container. • The nurse needs to consider socioeconomic factors for all clients. • Medication errors must be reported according to the policy of the hospital. Asma Falak/SON, PIMS 96
  • 97. Medication Error Asma Falak/SON, PIMS 97 • Medication errors are unintended mistakes in the prescribing, dispensing and administration of a medicine that could cause harm to a patient.
  • 98. • Medication errors can occur at all stages of the medication administration process. • The four main types of medication errors that occur with hospitalized clients: 1. Prescription errors (eg. Wrong drug or dose) 2. Transcription/ interpretation error (eg. Misinterpretation of abbreviations) 3. Preparation errors (eg. Calculation error) 4. Administration errors (eg. Wrong dose, wrong time, omission, or additional dose). Most medication errors occur during the administration stage. Asma Falak/SON, PIMS 98

Editor's Notes

  1. Orally Drug must be soluble and stable in stomach fluid (not destroyed by gastric acids), enter the intestine, penetrate the lining of the stomach or intestine, and pass into the blood stream.
  2. Effect of pH: Most drugs are either weak acids or weak bases. Weak electrolytes, in addition to lipid solubility, depends upon its degree of ionization which is influenced by pH of the area. Weak acids become less ionized(charged) in an acidic medium and weak bases become less ionized in an alkaline medium Unionized drug is lipid soluble and diffusible. ipid soluble(hydrophobic), uncharged, unionized will cross the membrane rapidly than lipid insoluble(hydrophilic or water soluble),charged and ionized. Basic drug will absorb more from intestine because it becomes unionized in basic medium. In acidic medium basic drug will become more ionized and thus no absorption will takes place. Functional integrity of the GIT: Increased peristaltic activity as in diarrhea reduces drug absorption Increased gastric emptying time, absorption will be more.