The document outlines various aspects of pharmacology, including medication types, administration principles, storage, and calculations. It explains the significance of medications for prevention, diagnosis, suppression, treatment, and cure, as well as the medication administration rights and checks. Additionally, it provides detailed information on drug forms, routes of administration, and the importance of calculating doses and fluid therapy in clinical practice.

1. PANDIARAJAN. K
M.Sc, (Ph.D)

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.

3. Uses of Drugs
 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.

4.  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

5. Storage of Medications
• 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 ONL
Y.

6. • Cupboard II-contains drugs for internal
use only e.g. tablets, suspension, mixtures
etc. All drugs must be labelled.
• 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
.

7. • 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.

8. Principles of medication
administration
• 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
.

9. Rights of Medication Administration
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.

10. 2. Right Medication:
 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.

11. 3. Right Time
 Right Time: drug timing is very especially
with somedrugs 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 related
withbloodconcentrations.

12. 4. Right Dose
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.

13. 5. Right Route
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
.

14. Types of Medication Orders
• 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. (sedativedrug)

15. 3. Standing order: Standing order is written in
advance carried out under specific
circumstances. (e.g: amox twice daily ×
2days)
4. PRN order: “PRN” is a Latin term that
stands for “prore nata,” A PRN order or
as-needed order, permits thenurse to give a
medication when the client requires it.
(e.g., Amphojel 15 mL prn) (for indigestion,
heartburn, increased stomach acid)

16. Abbreviations Meaning
ac
 before meals
AM
 morning
bid  twiceper day
Cap  capsule

17. 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

18. Abbreviations Meaning
qid  four times per day
q2h,q4h,
q6h, q8h,
q12h
 every hours
Rx  take
ST
A
T  immediately
, at once
tid  three times per day
tab  tablet

19. Drug forms
• Medication
s
are available in variety
of
forms. The form of the
medication determines its route of
administration.

20. • Drug forms can be of three
types;
– Solid eg: tablet, capsule
– Liquid eg: syrup, eye drops
– Semi solid eg: ointment, lotion

21. • 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.

22. • 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
.

23. • Powder: Single or mixture
of finely ground drugs.
• Solution: Adrug dissolved
in another substance.
• Suspension: Finely divided,
undissolved particles in a
liquid medium; should be
shaken before use. (Paediatric
dosewithattractivecolourand
flavour)

24. • Syrup: Medication
combined in a water
and sugar solution.
• Suppository: An easily
melted medication
preparation in a firm
base suchas gelatin that
is inserted into the body
(rectum, vagina,
urethra)

25. • Transdermal patch: Unit dose of
medication applied directly to skin
for diffusion through skin and
absorption into the bloodstream.

26. Route of administration
• Different route of drug administration
are;
• Oral
• Parenteral
• Topical
• Inhalation

27. Oral route
Oral route: Medicationsare
given by mouth.
• Sublingual Administration:
Some medications are readily
absorbed when placed under the
tongue to dissolve.
• Buccal Administration:
Administration of a medication
by placing in themouth against
the
mucous membranes of the cheek
until it dissolves.

28. Parenteral Routes
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 underthe 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.

30. Equipment
• To administer parenteral medications,
nurses use syringes and needles to
withdraw medication from (A) ampules and
(B)vials.
Ampul
e
via
l

31. Syringes
Syringes have three parts:
1. The tip, which
connects with
the needle
2. The barrel, or
outside part, on
whichthe scales are
printed
3. The plunger, which
fits inside the barrel

32. Several kinds of syringes are available
in differing sizes, shapes, and materials.
Syringes range in sizes from 1 to 60 mL.
A nurse typically uses a syringe
ranging from 1 to 3 mL in size for
injections (e.g. subcutaneous or
intramuscular).

33. • Insulin syringes are
available in sizes that hold
0.3 to 1 mL and are
calibrated in units.
• The tuberculin syringe has
a capacity of 1 mL.
• 3 ml syringe
• 5 ml syringe

34. Needles
• Most needles are made
of stainless steel, and
all are disposable.
• A needle has three
parts:
1. The hub, which fits
onto the tip of a
syringe
2. The shaft, which
connects to the
hub
3. The bevel, the tip
of the needle
• The gauge varies from 18 to 30.
• Use longer needles for IM injections
and a shorter needle for subcutaneous
injections.

35. Needle
size
• 19
gauge
• 20
gauge
• 21
gauge
• 23
gauge

36. Cannula
A cannula is a flexible tube that can be
inserted into the body. A venous cannula is
inserted into a vein, for the administration of
intravenous fluids, for obtaining blood
samples and for administering medicines.
Types of cannula are
• IV cannula pen-like model.
• IV cannula with wings model.
• IV cannula with injection part
model.
• IV cannula y-type model.

38. Preventing needle stick
injuries
• One of the most potentially hazardous
procedures that health care personnel
face is using and disposing of needles
and sharps.
• Needlestick injuries present a major
risk for infection with hepatitis B
virus, human immunodeficiency
virus (HIV), and many other
pathogens.

39. SCOOP METHOD
a) placing the needle cap and syringe
with needle horizontally on a flat
surface.
b) inserting theneedle into the cap, using
one hand.
c) then using your other hand to pick up
the cap and tighten it to the needle
hub.

40. • Epidural: Epidural
medications are
administered in
the epidural
space. (spine)
• Intrathecal:
Administration of
medications into
subarachnoid space
or one of the
ventricles of the
brain.
Some medications are administered into body
cavities. These additional routes include

41. • Intraosseous: Administration
of medication directly into the bone
marrow.
• Intraperitoneal: Medications
administered into the peritoneal cavity
• Intrapleural: Administration
of medications directly into the pleural
space.(lungcavities)
• Intraarterial: Intraarterial medications
are administered directly into the arteries.

42. Broad Classification of drugs
• Adrug may be classified by the chemical
type of the 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 treatbacterial infection
• Anti viral: to treat viral infection
• Antihypertensive : to treat hypertension
• Antidiabetic: to treat diabetes

43. Dose Calculations
Methods used to calculate medication
doses include
• The ratio and proportion method
• The formula method
• Dimensional analysis

44. • The Ratio and Proportion Method: A ratio
indicates the relationship between two
numbers separated by a colon (:).
Example 1: 1:2 = 4:8
Example 2: 1:2 :: 4:8
Example 3: 1/2 = 4/8
Metric system Household system
1 ml 15 drops
5 ml 1 teaspoon
15 ml 1 tablespoon

45. Example: The prescriber orders 500 mg
of Syp. amoxicillin to be administered in
every 8 hours. The bottle of amoxicillin is
labeled 400 mg / 5 mL.
i.e -500*5/400=6.25ml

46. Formula method
1. Calculating dose of solid medications
First convertthe drug amount to the same
units and then use the formula.
𝒔𝒕𝒐𝒄𝒌
𝒔𝒕𝒓𝒆𝒏𝒈𝒕𝒉
Dose required= 𝒔𝒕𝒓𝒆𝒏𝒈𝒕𝒉 𝒓𝒆𝒒𝒖𝒊𝒓𝒆𝒅
= no of tab.
Stock strength is the strengthofdrug
written on the cover
.
E.g-Administertab.para250mg?
Eg:paracetamol250mg/500mg=½tablet

47. 2. Calculating dose of liquid medications
First convertthe drug amount to the same
units and then use the formula
Volume required=
ℎ
𝑠𝑡𝑟𝑒𝑛𝑔𝑡 𝑟𝑒𝑞𝑢𝑖𝑟𝑒𝑑×𝑣𝑜𝑙𝑢𝑚𝑒 𝑜𝑓 𝑠𝑡𝑜𝑐𝑘
𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛
𝑠𝑡𝑜𝑐𝑘 ℎ
𝑠𝑡𝑟𝑒𝑛𝑔𝑡
Example:
The ordered dose is Ceftriaxone 750 mg IV. the container contain 1g in a 10 ml
vial.
How to calculate?
You should convert first g to mg , then :
(D) 750 mg X (V) 10 ml = 7.5 ml
(H) 1000 mg

48. What is a drop factor?
•Drop factor is the number of drops in one
milliliter used in IV fluid administration (also
called drip factor). A number of different
drop factors are available but the
Commonest are:
1 10 drops/ml (blood set)
2 15 drops / ml (regular set)
3 60 drops / ml (microdrop, burette)

49. How to calculate IV flow rates ?
•Example:
1500 ml IV Saline (3 bottles) (1 bottle=5ooml) is ordered over 12 hours.
Using a drop factor of 15 drops / ml, how many drops per minute need
to be delivered? (1 pint = 500ml)
1500 (ml) X 15 (drop / ml)
--------------------------------------
12 x 60 (gives us total minutes)
= 31 drop/ minute
The formula for working out flow rates is:
volume (ml) X drop factor (gtts / ml)
= gtts /
min
---------------------------------------------
time (min)

50. Importance !
• Can be life-saving in certain conditions
•Loss of body water, whether acute or chronic, can cause a
range of problems from mild headache to convulsions,
coma, and in some cases, death.
•Though fluid therapy can be a lifesaver, it's never
always safe, and can be very harmful.
FLUIDTHERP
Y

51. The fluids used in clinical practice are usefully
classified into colloids, crystalloids and blood
products
1.Colloid
Solutions that contain large molecules that don't
pass the cell membranes.
When infused, they remain in the intravascular
compartment and expand the intravascular volume
and they draw fluid from extravascular spaces via
their higher oncotic pressure
Types of Fluid

52. 2.Crystalloid
Solutions that contain small molecules that flow easily
across the cell membranes, allowing for transfer from the
bloodstream into the cells and body tissues.
This will increase fluid volume in both the interstitial
and intravascular spaces (Extracellular)
It is subdivided into:
 Isotonic- same like plasma concentration
 Hypotonic-less than plasma concentration
 Hypertonic-more than plasma concentration
Types of
Fluid

53. When to consider a solution isotonic?
When the concentration of the particles (solutes) is
similar to that of plasma, So it doesn't move into
cells and remains within the extracellular
compartment thus increasing intravascular volume.
Isotonic
Fluids

54. Types of isotonic solutions
include:
0.9% sodium chloride (0.9%
NaCl)
lactated Ringer's solution
5 % dextrose in water (D5W)
Ringer's solution
Isotonic
Fluids

55. A- 0.9% sodium chloride (Normal
Saline)
•Simply salt water that contains only water, sodium (154 mEq/L),
and chloride (154 mEq/L).
•It's called "normal saline solution" because the percentage of
sodium chloride in the solution is similar to the concentration of
sodium and chloride in the intravascular space.
Isotonic
Fluids
K+ Ca2+ Mg2+ HCO3
-
Dextrose
Solutions Na+
0.9% NaCl 154
Cl-
154
mOsm/
L
308

56. 1. Severe vomiting or diarrhoea
2 Shock
3 Mild hyponatremia
4Metabolic acidosis (such as diabetic ketoacidosis)
5- It’s the fluid of choice for resuscitation efforts.
6- it's the only fluid used with administration of
blood products.
A- 0.9% sodium chloride (Normal Saline)
When to give?

57. ois the most physiologically adaptable fluid because its
electrolyte content is most closely related to the
composition of the body's blood serum and plasma.
o Another choice for first-line fluid resuscitation for
certain patients, such as those with burn injuries.
B- Ringer's lactate or Hartmann solution
S olu tio n s N a +
K
+
C a
2 +
M g
2 + Cl-
H C O 3
-
Dextrose m O sm /L
Lacta ted
R in ger’s
130 4 3 109 28 273

58. B- Ringer's lactate or Hartmann solution
When to be used?
T
o replace GI tract fluid losses ( Diarrhea or vomiting )
Fluid losses due to burns and trauma
Patients experiencing acute blood loss or hypovolemia
Don’t Use
-Don't give LR to patients with liver disease as they can't metabolize
lactate
-used cautiously in patients with sever renal impairment because it
contains some potassium
- LR shouldn't be given to a patient whose pH is greater than 7.5

59. C-Ringer's solution
Like LR, contains sodium, potassium, calcium and
chloride in similar. But it doesn't contain lactate.
Ringer's solution is used in a similar fashion as LR,
but doesn't have the contraindications related to
lactate.(Can given in metabolic acidosis, alkalosis)

60. • It is considered an isotonic solution, but when the
dextrose is metabolized, the solution actually becomes
hypotonic and causes fluid to shift into cells.
• It provides 170 calories per liter
D- Dextrose
5
%
Solutions Na
+
K
+
Ca
2+
Mg
2+
Cl
-
-
HCO3 Dextrose mOsm/L
D5W 50gm/l 278

61. Take Care !
-D5W is not good for patients with renal failure or cardiac problems since
it could cause fluid overload.
-patients at risk for intracranial pressure should not receive D5W since
it could increase cerebral edema
-Never mix dextrose with blood as it causes blood to hemolyze.
-Not used for resuscitation, because the solution won't remain in
the intravascular space.
-Not used in the early postoperative period, because the body's reaction
to the surgical stress may cause an increase in antidiuretic hormone
secretion
D- Dextrose 5 %

62. Indications for GI Intubation
■ To decompress the stomach and remove gas and liquids
■ To lavage (removal) the stomach and remove ingested
toxins
■ To administer medications and feeds e.g. Post operative
or unconscious patient (gag or swallowing reflex
absent)
■ As part of the management of an obstruction i.e Tumor
oesophagus,
■ As part of the management of haematemesis i.e
oesophgeal variceas.
■ To aspirate gastric contents for analysis

63. Technique continued…
■ Explain procedure to patient and relatives
■ Position the client in a sitting or high Fowler’s
position. If comatosed, semi Fowler’s.
■ Examine feeding tube for flaws.
■ Determine the length of tube to be inserted.
■ Measure distance from the tip of the nose to the
earlobe and to the xyphoid process of the sternum.
■ Prepare NG tube for insertion.

64. Implementation
1) Wash Hands
2) Put on clean gloves
3) Lubricate the tube
4) Hand the patient a glass of water
5) Gently insert tube through nostril to back of
throat (posterior naso pharynx).
Have the patient flex the head towards the chest
after tube has passed through nasopharynx.

65. Implementation Cont.
6)Emphasize the need to mouth breathe and swallow during
the procedure.
7)Swallowing facilitates the passage of the tube through the
oropharynx.
8)When the tip of the tube reaches the carina stop and listen
for air exchange from the distal end of the tube. If air is heard
remove the tube.
9)Advance tube each time client swallows until desired
length has been reached.
10)Do not force tube. If resistance is met or client starts to
cough, choke or become cyanotic stop advancing the tube and
pull back.

66. Implementation Cont.
11) Check placement of the tube.
Pushing air
Testing pH of
aspirate
X-ray confirmation
12) Secure the tube
with tape or
commercial device.

67. Enteral Nutrition(GAVAGE) OR
Naso Gatric Tube feeding
■ What is it:
■ The administration of nutrients directly into
the GI tract. The most desirable and
appropriate method of providing nutrition
is the oral route, but this is not always
possible.
■ Nasogastric feeding is the most common
route
■ Nurses are the main healthcare
professional responsible for intubation

68. Administering Enteral Feeds
■ Indications:
■ Clients who are unable to maintain
adequate oral intake to meet metabolic
demands
■ Surgical cases
■ Ventilator patients
■ Neuromuscular impairment
■ Generally these clients have been referred

69. Enteral and Parenteral feeding
• What is enteral and parenteral feeding?
• The main difference between enteral and
parenteral feeding is that enteral feeding is
the delivery of food via the human
gastrointestinal tract.
• In contrast, parenteral feeding is the delivery
of food into the bloodstream, bypassing the
gut.

70. Total Parenteral Nutrition
Intravenous administration of
varying combinations of
hypertonic or isotonic glucose,
lipids, amino acid, electrolytes,
vitamins and trace elements
through a venous access device
(VAD) directly into the vein.
.

71. Purposes
⚫To provide nutrients required for
the normal metabolism, tissue
maintenance, repair and energy
demands.
⚫To bypass the GI tract for patients
who are unable to take food orally.

72. Methods of parenteral nutrition
⚫Total Parenteral Nutrition (TPN)
◦ It is indicated for patients requiring
parenteral feeding for seven or more
days.
◦ Given through a central vein often into
the superior venacava.

73. Methods of parenteral nutrition
⚫Peripheral parenteral nutrition
◦ This parenteral formula combines
carbohydrates a lesser concentrated
glucose solution with amino acids,
vitamins, minerals
◦ Given through peripheral vein
◦ Indicated for patients requiring nutrition for
fewer less than 7 days

74. Central venous access devices