MODULE 1- BASIC CONCEPTS IN CONTRAINDICTION

PHARMACOLOGY -The conditions and circumstances which the

COMMON TERMINOLOGIES USED drug is undesirable to use and caution must be
given (Woods,Vaughn, et.al, 2020)
DRUG
SIDE EFFECTS
-A substance which has a physiological effect
when ingested or otherwise introduced into the -Are secondary effects of drugs which may be
body (Oxford Dictionary) predictable resulting to either desirable or
undesirable effects. This reaction may be
PHARMACOLOGY different from one patient to another
- The study of the biological effects of chemicals (McCuistion, et al, 2018).
on living organisms (Karch, 2016). ADVERSE DRUG REACTIONS (ADRs)
PHARMACOKINETICS -Are drug effects which is unintentional and/or
- The process of drug movement to achieve unexpected after administration of drug in
drug action. The four processes that completes normal dosage (McCuistion, et al, 2018).
pharmacokinetics include: ADME-absorption, DRUG TOXICITY
distribution, metabolism and excretion
(McCuistion, et al, 2018) -Occurs when drug exceeds the therapeutic
drug level which may be caused by improper
PHARMACOTHERAPEUTICS prescription and administration and/or due to
-Also known as clinical pharmacology is the genetics, age, disease process including co-
science which deals with use of drugs in morbidities.
treatment, prevention and diagnosis of diseases NURSING RESPONSIBILITIES
(Karch 2016).
-The use of nursing process in drug
DRUG CLASSIFICATIONS administration using appropriate assessment,
-Various categorization of drugs which include diagnosis, plan of care, intervention and
classification of drugs according to: a) body evaluation (ADPIE).
systems; b) regulation of substance abuse c)
therapeutic use, and d) physiologic or chemical
actions.

MECHANISM OF ACTION

-This explains how the drug provides a

therapeutic effect including the effects that
happen when the drug combines with cellular
drug receptors (Woods,Vaughn, et.al, 2020).

THERAPEUTIC INDICATION

- The disease/s to be treated by the given

medicine and the individuals for which it is
intended (EUPATI, 2020)

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DRUG REGULATION CLASSIFICATION AND EXAMPLES

FDA’s main function: According to BODY SYSTEMS

To protect and promote the right to health of CNS drugs, Cardiovascular drugs, Respiratory
the Filipino people and to establish and drugs, Kidney drugs
maintain an effective health products regulatory
According to THERAPEUTIC USE
system responsive to the country’s health needs
and problems. Antacids, Antibiotics, Antihypertensive,
diuretics, or laxatives

According to CHEMICAL and PHYSIOLOGIC

SOME OTHER FUNCTIONS OF THE FDA
ACTIONS
1. Establishes safety or efficacy standards and
Anticholinergics, Beta-adrenergic blockers,
quality measures for foods, drugs and cosmetics
Calcium channel blockers, Cholinergics.
2. Analyzes and inspects health products

3. Helps the public get the accurate, science-

PREGNANCY CATEGORY
based information needed to use medicines and
foods to maintain and improve their health CATEGORY A
4. Helps to speed innovations that make -Adequate studies in pregnant women have not
medicines more effective, safer, and more demonstrated a risk to the fetus in the first
affordable trimester of pregnancy, and no evidence of risk
in late trimester.
5. Issues certificates of compliance, cease and
desist orders  Example include multivitamins
6. Conducts, supervises, monitors and audits CATEGORY B
research studies on health and safety issues of
health products -Animal studies have not demonstrated a risk to
the fetus but there are no adequate studies in
7. Prescribes standards, guidelines and pregnant human, OR;
regulations with respect to information,
advertisement and marketing -Animal studies have shown an adverse effect,
but adequate studies in pregnant humans have
not demonstrated a risk to the fetus in the first
trimester of pregnancy, and no evidence of risk
in late trimester

 Examples include certain antibiotics

such Amoxicillin and Penicillin

CATEGORY C

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-Animal studies have shown an adverse effect -Drugs or substances that have a potential for
on the fetus but there are no adequate studies abuse less than Schedule I or II; currently have
in humans; the benefits from the use of the an accepted medical use; abuse may lead to
drug in pregnant women may be acceptable moderate or low physical and high
despite its potential risks psychological dependence. (some sedatives,
anti-anxiety and non-narcotic analgesics)
 Examples include Aspirin,
Fluoroquinoles, Gentamicin Classification IV Schedule 4 (S4)

CATEGORY D -Drugs or substances that have a low potential

for abuse relative to those listed in Schedule III;
-There is evidence of human fetal risk, but the
currently have an accepted medical use; abuse
potential benefits from the use of the drug in
may lead to limited physical or psychological
pregnant women may be acceptable despite its
dependence those in schedule III.
potential risks
Classification V Schedule 5 (S5)
 Examples include Tetracyclines,
Chemotherapy drugs, ACE inhibitors -Drugs or substances that have a low potential
for abuse relative to Schedule IV; may not need
CATEGORY X
prescription by a doctor (Over-the-Counter or
-Teratogenic. Evidence of fetal harm is OTC drugs).
established. May cause congenital disease or
death of the fetus.

 Example includes contraceptive drugs

SUBSTANCE ABUSE CATEGORY

Classification I Schedule 1 (S1)

-Drugs or substances that have a high potential

for abuse; no currently accepted medical use
and have a lack of accepted safety for use under
medical supervision. (Heroin, marijuana).

Classification II Schedule 2 (S2) :(Yellow

prescription drugs)

-Drugs or substances that have a high potential

for abuse; currently have an accepted medical
use in treatment but with severe restrictions;
abuse may lead to severe psychological or
physical dependence. (narcotics,amphetamines,
barbiturates). purchaser must be at least 18
years old, and all transactions must be recorded
by the dispensing pharmacist.

Classification III Schedule 3 (S3)

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DRUG NAMES, FORMS, AND ROUTE 4. Transdermal – patch absorbed in the skin

DRUG NAMES 5. Topical – applied to the skin

Drugs has several names: 6. Instillation (eye drops, ear drops, nose drops
and sprays, and eye ointment)
Chemical name - describes the drug’s chemical
structure. used by scientists in studying and 7. Inhalation - delivered deep into the lungs
manufacturing the drug with each puff (e.g., Metered-dose inhaler)

Generic name - is the official or nonproprietary 8. Nasogastric and gastrostomy tubes –

name for the drug. This is not owned by any delivered via feeding tube that enters the
pharmaceutical (drug) company and is mouth, nose, or abdomen
universally accepted. Most drugs are ordered by
9. Suppositories –inserted into the rectum,
generic name. Written in a lowercase letter.
vagina, or urethra
Brand (trade) name - is also known as the
10. Parenteral forms - administered thru
proprietary name, which is chosenby the drug
Intradermal (ID), Subcutaneous (SC),
company and is usually a registered trademark
Intramuscular (IM), intravenous (IV), and
owned by that specific manufacturer. Always
Intraosseous (IO)
begin in capital letter

Example: naloxone HCl (Narcan)

A. TABLETS AND CAPSULES
C19H21NO4
- most common drug forms

- convenient and less expensive and do not

require additional supplies for administration

Nursing considerations:

1. Oral drugs - are not given to patients who are

vomiting, who lack a gag reflex, or who are
comatose. Do not mix a drug with large
amounts of foods or beverages or infant
formula (patients may not consume them)
because they will not get the full dose of
medication.

 Enteric-coated and timed-release capsules

FORMS AND ROUTES OF DRUG - must be swallowed as a whole so the drug is
ADMINISTATION released gradually and maintain a therapeutic
1. Sublingual – placed under the tongue drug level. If crushed, the initial excessive drug
release poses a risk of toxicity (e.g., it could lead
2. Buccal – placed between the cheek and gum to a potentially fatal overdose. Crushing can
3. Oral (tablets, capsules, liquids, suspensions, also increase the rate of absorption, and could
and elixirs) –swallowed by mouth cause oropharyngeal irritation

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2. Sublingual drugs (under the tongue) 4. TRANSDERMAL

3. Buccal (between the cheek and gum) routes -Transdermal drugs provide more consistent
should remain in place until fully absorbed, blood levels than oral and injectable forms and
therefore no food or fluid should be taken while avoid GI absorption problems associated with
the medication is in place. oral products. Absorbed locally then
transported to systemic circulation

• Transdermal medication is stored in a patch

LIQUID
placed on the skin and is absorbed through the
Liquid medication includes elixirs, emulsions, skin to produce a systemic effect.
and suspensions.
• A patch may be left in place for as little as 12
- Syrup hours or as long as 7days depending on the
drug.
- Elixirs are sweetened, hydroalcoholic liquids
used in the preparation of oral liquid Nursing considerations
medications. Alcohol and water are used as
• To prevent skin breakdown, transdermal
solvents when the drug will not be dissolved in
patches should be rotated to
water alone. (eg., diphenhydramine).
different sites and should not be reapplied over
- Emulsions are a mixture of two liquids that are
the exact same area every time.
not mutually soluble.
• Area should be thoroughly cleansed before
- Suspensions are liquids in which particles are
administration of a new transdermal patch.
mixed but not dissolved.
• Perform hand hygiene and apply gloves when
Nursing considerations of Liquid forms:
administering medicated patches to prevent
• Read the labels to determine whether diluting transfer of medication; advise the patient to do
or shaking is required. the same for self-administration.

• Make sure your facility has plastic dosing cups • Never cut the patch in half.
that measure in milliliters (mL).

• To avoid mix-ups, it is always best to measure

5. TOPICALS
the prescribed dose of liquid medication in a
syringe calibrated mL and then squirt the -Topical medications are most frequently
medication into the oral measuring cup. applied to the skin by painting or spreading the
According to the U.S. Pharmacopeial convention medication over an area and applying a moist
a proposed change is required for all facilities to dressing or leaving the area exposed to air. This
supply dosing cups with legible markings in produces local effect
metric units
Nursing considerations

• Medications can be applied to the skin in

several ways:

• Using a glove,

5
• Using tongue blade, or cotton-tipped prescribed asthma and bronchitis drugs to the
applicator. lower respiratory tract via inhalation. MDIs act
faster than drugs taken by mouth, and fewer
Note: Nurses should never apply a topical
side effects occur because the drug goes right to
medication without first protecting their own
the lungs and not to other parts of the body
skin. This is to protect from transferring the
action of the drug to the nurses systemic Nursing considerations
circulation.
• Explain what a metered dose is, how it is
being administered, and warn the patient about
overuse and side effects of the drug
6. INSTILLATION
• Teach patients to rinse their mouth after using
-Instillations are liquid medications usually
an MDI. This is especially important when using
administered as drops, ointments, or sprays in
a steroid drug. Rinsing the mouth helps to
the following forms:
prevent irritation and secondary infection to
Nursing considerations oral mucosa. Advise patients to avoid smoking.

- Eyedrops - Gently pull down on the skin below

the eye to expose the conjunctival sac. Apply
7. NASOGASTRIC AND GASTROSTOMY TUBES
drops to the middle third of the sac, and apply
gentle pressure over the lacrimal duct after • Administration of drugs through a feeding
administration tube that enters the mouth, nose, or abdomen

- Eye ointments - Squeeze a ¼-inch–wide strip Nursing considerations

of ointment into the conjunctival sac
• Before administering drugs, always check for
- Eardrops - Straighten the external ear canal by proper tube placement, and always assess the
pulling the auricle down and back in children gastric residual
under 3 years of age. In patients older than 3
• Return any aspirated gastric fluid to the
years of age, including adults, pull the auricle
stomach. (Check the agency’s policy for tube
upward and outward
placement and residual)
- Nose drops - Advise patients to tilt the head
• Make sure the drug is crushable when
back for drops to reach the frontal sinus and to
administering it through tube feeding
tilt the head to the affected side to reach the
ethmoid sinus • Ensure to place patient in a high fowler
position or elevate the head of bed at least 30
-Nasal sprays - to reach the sinuses, proper
degrees to avoid aspiration
head position is with the patient looking down
at the feet with the spray tip aimed toward the • Flush with 10 to 15 mL of water in between
eye each administration to maintain patency of the
tubing

8. INHALATIONS

-Metered-dose inhalers (MDIs) are handheld

devices used to deliver a number of commonly

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9. SUPPOSITORIES • Explain the procedure to the patient and
provide privacy.
• A suppository is a solid medical preparation
that is cone- or spindleshaped for insertion into • Use glove for insertion.
the rectum, globular or egg-shaped for use in
• Instruct the patient to lie on the left side and
the vagina, or pencil-shaped for insertion into
breathe through the mouth to relax the anal
the urethra.
sphincter.
• Suppositories are made from glycerinated
• Apply a small amount of water-soluble
gelatin or high-molecular weight polyethylene
lubricant to tip of unwrapped suppository, and
glycols and are common vehicles for a variety of
gently insert the suppository beyond the
drugs. A suppository is a useful route in babies,
internal sphincter.
in uncooperative patients, and in cases of
vomiting or certain digestive disorders • Have patient lie on the side for 20 minutes
after insertion.
RECTAL SUPPOSITORIES
• If indicated, teach patients how to self-
-Medications administered as suppositories or
administer suppositories, and observe a return
enemas can be given rectally for local and
demonstration for teaching effectiveness.
systemic absorption. The numerous small
capillaries in the rectal area promote
medication absorption.
10. PARENTERAL- administered via injection.
VAGINAL SUPPOSITORIES
• Intradermal (ID) - Administered for skin
-Vaginal suppositories are like rectal testing (e.g., tuberculin screening, allergy
suppositories. They are generally inserted into testing and testing for other drug sensitivities,
the vagina with an applicator supplied with the some immunotherapy for cancer).
medication; gloves should be worn. The patient
should be in the lithotomy position. Advice • Subcutaneous (subcut) - Systemic effect,
patient to remain lying for a period of time to sustained effect; absorbed mainly through
allow medication absorption; times vary capillaries; usually slower in onset than with the
depending on medication. After insertion, intramuscular (IM) route.
provide the patient with a sanitary pad. • Intramuscular (IM) - Systemic effect, Usually a
Nursing Considerations more rapid effect of drug than with a subcut
route, Used for solutions that are more viscous
• The foil around the suppository is removed, and irritating for adults, children, and infants,
and the suppository may be lubricated before IM injections are associated with many risks, so
insertion. When medications such as antipyretic accurate, careful technique when administering
or bronchodilators are given, the patient must an IM injection is necessary
be reminded to retain the medication and not
expel it. • Intravenous (IV) - Systemic effect, More rapid
than IM or subcutroutes
• Suppositories tend to soften at room
temperature and therefore must be • Intraosseous (IO) - drug administration
refrigerated before use involves the infusion of medication directly into
the bone marrow

7
SAFETY AND QUALITY DRUG Note: Medication order must only be prescribed
by:
ADMINISTRATION
a. medical doctor, dentist podiatrist
SIX RIGHTS OF MEDICATION
ADMINISTRATION b. certified nurse practitioner, advanced
practice registered nurse
1. RIGHT PATIENT
2. RIGHT DRUG c. physician assistant, veterinarian,
3. RIGHT DOSE chiropractor, and optometrist.
4. RIGHT ROUTE d. medical clinical psychiatrists and
5. RIGHT TIME pharmacists have prescriptive authority
6. RIGHT DOCUMENTATION with strict guidelines set by the state.
7. RIGHT ASSESSMENT
8. PATIENTS RIGHT TO EDUCATION Prescriptions may be done by handwritten,
9. RIGHT TO EVALUATE telephone order or verbal order, or directly
10. RIGHT TO REFUSE entered the patient’s EHR.

1. Right patient – determining patient • to ensure accuracy All T/O or V/O are either
identification is an integral part of ensuring handwritten by the nurse taking the order or
patient safety. entered directly into a computer and “read
back” before affixing signature.
Two important ways of identifying the patient:
• If controlled drugs, 2 nurses are required to
1. Full name listen and affix their signature.
2. birth date. • After dictating a verbal order, the provider
Then compare with the patient’s must sign it within 24 hours.

A. identification (ID) band and the medication Note: Nursing students are not allowed to
administration record (MAR). accept or take provider orders.

B. Electronic health records (EHRs) that allow The components of a drug order are as follows:
the nurse to directly scan the bar code from the 1. Patient name and birth date
ID band.
2. Date the order is written
• If the patient is an adult with a cognitive
disorder or a child, verify the patient’s name 3. Provider signature or name if an electronic
with a family member. If family member is order, T/O, or V/O
unavailable, a photo ID on the band with the
4. Signature of licensed staff who took the T/O
patient’s name and birth date could be affixed
or V/O, if applicable
to the band.
5. HCPs who wish to prescribe controlled drugs
must register with the Drug enforcement
2. Right Drug - The nurse must accurately agency (DEA) or FDA. When prescribing
determine the right drug prior to controlled substances, the HCP’s DEA/FDA
administration. number must be on the prescription.

8
6. Drug name and strength dose vial, it should be properly disposed
according the sanitation or hospital policy.
7. Drug frequency or dose (e.g., once daily)

8. Route of administration
4. Right Time – includes the time the
9. Duration of administration (e.g., × 7 days, × 3
prescribed dose is ordered to be administered.
doses, when applicable)
To maintain therapeutic level of the drug in the
10. Number of pills to be dispensed blood plasma level, a daily prescribed order
should have specified intervals.
11. Any special instructions for withholding or
adjusting dosage based on nursing assessment, Example of specified intervals for the drug
drug effectiveness, or laboratory results order includes:

To avoid medication errors, the drug label 1. once a day

should be read three times: 2. twice a day (bid) or every 12 hours

1. When you pick up the medication and 3. three times a day (tid) or every 8 hours
remove it from the drug cabinet
4. four times a day (qid), or every 6 hours (every
2. As you prepare the drug for administration 6hrs)
Note: Use of military time (24-hour clock) is
3. When you administer the drug
recommended in the healthcare facility rather
than the standard time because it reduces
administration errors.
3. Right Dose - administration of correct
amount of drug ordered that it is safe for the
patient. The right dose must be based on the
patient’s physical status including the patient’s
weight

- Always recheck the drug calculation if the dose

is within a fraction or if it is an extremely large
dose. Consult another nurse or the pharmacist
when in doubt.

Method of dispensing the drug:

1. Automated dispensing cabinets – the use of 5. Right Route - is necessary for adequate or
computerized drug storage cabinet that stores appropriate absorption. It is ordered by the
and dispense medications near the point of care health care provider and indicates the
mechanism by which the medication enters the
2. Unit dose (single dose) - has reduced dosage
body.
errors because no calculations are required

3. Multidose vial - requires calculations to

withdraw an exact amount of drug according to
the dose required. If something left in the multi-

9
6. Right Assessment - requires the collection 8. Right to Education - The nurse should
of appropriate baseline data before accurately and thoroughly inform the patient
administration of a drug. about the drugs they are taking and how each
drug relates to their condition. Teaching also
Example of right assessment
includes:
1. taking a complete set of vital signs
• Why the patient is taking the drug, what is the
2. checking lab levels prior to drug expected result of the drug, its possible good
administration /therapeutic effects, side effects and adverse
effects, and if there are any dietary restrictions
3. Identify high-risk patients so precautions to or requirements.
reduce risk could be given (e.g., patients with
medication allergies, diabetic patients, cardiac • Laboratory test result monitoring and the
and pulmonary patients, and the elderly and necessary skills of drug administration with
pediatric populations). return demonstration before discharge. This
facilitates continuity of care at home upon
discharge.
7. Right Documentation - requires the nurse
to record immediately the appropriate
information about the drug administered. 9. Right Evaluation - determines the
effectiveness of the drug based on the patient’s
Method of documenting drug administration: response to the drug.
1. Paper medication administration record • The nurse should ask the patient whether the
(MAR) - is the commonly used method specially medication improve the present health
in the Philippines as per observation condition.
2. Computerized charting - nurse enters a • The nurse should evaluate the therapeutic
personal identification and password to get effect of the medication by assessing the
access into the system. patient response to the drug.
Note: • A drug that is given but not Example: Patient response to an antiemetic,
documented is considered not given and a drug antihypertensive, and antihistamine
that is not given but documented is considered
given. It is important that nurses must
remember that drugs should be signed
10.Right to Refuse - patient has the right to
immediately after the drug is administered
refuse the medication.If the patient refuse the
medication:

• The nurse’s is responsible to determine the

reason for the patient refusal to medication

• The nurse should explain to the patient the

“risks involved with refusal”, and reinforce the
important benefits of and reasons for taking the
medication.

10
• When a medication is refused, the refusal 2. List of acceptable abbreviations - are
must be documented immediately, and follow- abbreviations that are frequently used in drug
up is always required. The primary nurse and therapy and must be known by the nurse
health care provider should be informed
because the omission may pose a specific threat
to the patient (e.g., a change in the lab values
with insulin and warfarin).

Nurses six rights of administering

medication:
1. the right to a complete and clear order (e.g.,
nurses may clarify a HCP order that is not clear
because it is not legibly written or a verbal or
DISPOSAL OF MEDICATION
telephone order that are sounds like or sounds
alike. • Appropriate disposals of used drugs are
important to decrease the amount of controlled
2. the right to have the correct drug, route
substances released into the environment,
(form), and dose dispensed
especially into water and sewage system.
3. the right to have access to information Unless instructed, do not flush drugs down the
toilet so not to pollute environment and danger
4. the right to have policies to guide safe
human and animals. List of drugs that could be
medication administration
flushed were listed in your reference book pp.
5. the right to administer medications safely 80 (e.g., Abstral, Demerol, and etc)
and to identify problems in the system
• Facilities may contract with an independent or
6. the right to stop, think, and be vigilant when local collection program company authorized by
administering medication the state and the FDA/DEA.

• The drugs are disposed in a receptacle that

must comply with strict security and record-
The Joint Commission National Patient Safety keeping requirements as established by the
Goals (TJC) FDA/DEA. The company then incinerate the
Two important goals that have already become waste.
standards for all TJC

1. “Do not use” abbreviations - orders that

should be written to avoid misinterpretation SHARPS SAFETY/ NEEDLE-STICK INJURY

Nurses should not risk their lives every time

they use a sharp object or needle.

• Sharps safety prevent incidents of blood-

borne related disease such as the HIV/AIDS or
Hepatitis B.

11
• The Needle-stick Safety and Prevention Act Examples of high alert drugs:
(NSPA) requires that employers implement
1. epinephrine
safer medical devices for their employees,
provide a safe and secure workplace 2. Insulin (all forms)
environment with educational opportunities,
and develop written policies to help prevent 3. magnesium sulfate injection
sharps or needle-stick injuries. This will include 4. opium tincture
a flowchart of pre-post exposure management.
5. potassium chloride concentrates for injection
• Use puncture-proof containers to dispose of
sharps and needles. Containers must be closed, Lists to reduce risk of errors in administering
puncture resistant, leak proof, color coded, and high alert medication:
emptied routinely to prevent overfilling 1. Simplify the storage, preparation, and
administration of high-alert drugs

SAFETY RISK WITH MEDICATION 2. Write policies concerning safe administration

ADMINISTRATION 3. Improve information and education
1. Tablet splitting - some patients are cutting 4. Limit access to high-alert medications
their pills in half. However, this is not
recommended by the FDA. The only time tablet 5. Use labels and automated alerts
splitting is advisable is when it is specified by
6. Use redundancies (automated or
the pharmacist on the label
independent double-checks)
2. Buying drugs over the Internet - precautions
7. Closely monitor the patient’s response to the
must be taken because drugs sold online may
medication (possibly the most important step)
be too old, too strong, or too weak to be
effective and are unsafe to use with other
medications
 Look-Alike and Sound-Alike Drug Names
3. Dosage Forms: To Crush or Not to Crush - Do
• Nurses should be aware and give emphasis
not crush any extended- or sustained-release
that certain drug names sound alike and are
drugs because this will change the
spelled similarly is prone to medication error
pharmacokinetic phase of the drug. Although
and should not be practiced in the clinical
some drugs can be used crushed, some should
settings.
not be crushed. Always consult with the
pharmacist or, when possible, the health care Example:
provider prior to crushing a patient’s drug.
1. glypizide (Glucotrol) with glyburide
4. High-Alert Medications - can cause (Glyceron)
significant harm to the patient. If a highalert
medication is given in error, it can have a major 2. Glimepiride (Amaryl) with galantamine
effect on the patient’s organs such as cardiac, (Reminyl).
respiratory, vascular, and neurologic systems. Note: To prevent this incident, nurses should
always practice the Six plus 4 Rights of
medication administration.

12
13
DOSAGE CALCULATIONS  Grams ( g, mg, kg, mcg)
 Liters (l, ml, )
TERMINOLOGIES
 Meter (m, cm, km)
POSOLOGY- the study of dosage of medicines.
2. Apothecary system:
1. Minimum dose – the least dosage amount of
- Apothecaries means pharmacist
a drug that can be given to achieve a
- an old system used for measuring and
therapeutic effect (in a day)
weighing drugs and solutions by use of
2. Maximum dose – the highest dosage amount fractions
that can be given in a day, if it exceeds, toxic
➢ Ounce ➢ Grains
effect may occur
➢ Pound ➢ Dram
3. Daily dose – the total dosage amount that is
given to a patient in a day to achieve ➢Quart ➢Pint
therapeutic effect
➢Minim ➢Gallon
4. Maintenance dose – the total dosage amount
that must be given to maintain a state of
wellness 3. Household system

5. Single dose – the dosage amount that is given Teaspoon Tablespoon

only once
Fluid ounces Cups
6. Loading dose -the amount of drug which is
Pints Quarts
given more than the usual dose because the
drug action is needed quickly Gallon

7. Toxic dose - the amount of drug which when Other systems:

given will cause danger to the patient and
A. Milliequivalent (mEq):
possible death
 refers to the ionic activity of the drug
8. Lethal dose - the amount of drug which when
 measures electrolytes
given will cause imminent death to the patient
B. International Units (IU):

THREE MEASURING SYSTEM  Measures certain vitamins or enzymes

M-A-H

1. Metric system

2. Apothecary system

3. Household system

1. Metric system- an internationally

agreed decimal system of measurement

14
Calculation Methods Calculation by weight

Three methods can be used: Required Dose = Weight in kgs X Dosage per kg

1. Basic Formula Practice computation: Answer

2. Ratio-Proportion calculation (R/P) 1. Give Tramadol 2 mg/kg of body weight.

Weight of patient is 125 lbs.
3. Dimensional analysis (D/A)
Answer:
 These methods are used to calculate most
enteral and parenteral drugs dosages. RD = wt. in kg x dosage/kg

125lbs/2.2 = 56.81kg x 2mg = 113.63mg

Formula 1: Weight conversion 2. Give Acetaminophen 12.5 mg/kg every 4
1 kg = 2.2 lbs hours for pediatric patient weighing 14 kgs.

1. Pounds (lbs) to Kilogram (Kg) Answer

→ Use DIVISION RD = wt. in kg x dosage/kg

→ ____lbs. / 2.2lbs = ____ kgs. 14 kg x 12.5 mg = 175 mg every 4 hours

2. Kilogram (kg) to Pounds (lbs) 3. Give Tamiflu 3mg/kg/day divided into 2 doses
for infants weighing 9.8 kgs.
→Use MULTIPLICATION
Answer
→ ____kgs x 2.2 lbs. = ____ lbs
RD = wt. in kg x dosage/kg

9.8 kg x 3mg = 29.4 mg / day

Convert:
14.7 mg / dose
1. 45 lbs to kgs → 45 lbs / 2.2 lbs → 20.45 kgs

2. 126 lbs to kgs → 126 lbs / 2.2 lbs → 57.27 kgs

PEDIATRIC DOSAGE
3. 10 kgs to lbs → 10 kgs X 2.2 lbs → 22 lbs
Reason is:
4. 69 kgs to lbs → 69 kgs X 2.2 lbs → 151.8 lbs
Immaturity of child’s organ

 Pharmacokinetics (ADME) is different from

adult
 Smaller dose to achieve comparable critical
concentration
 Research cannot be done to children for
ethical reasons
 Dosage calculation allows to identify
recommended dose

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Pediatric dose calculation YOUNG’S RULEALWAYS use AGE

Calculation of pediatric dose

Clark’s rule Pediatric dose: Fried’s rule

Child’s dose = infant’s age (in months) X average adult dose
Adult Dose X (Weight ÷ 150)
150 months
Young’s rule

Adult Dose X (Age ÷ (Age+12))

Exercise #1
Fried’s rule
Adult dose = 500 mg every 8 hours
infant’s age (in months) X Average adult dose
Infant’s age = 2 months
__________________
Exercise #2
150 months
Adult dose = 500mg every 6 hours

Infant’s age = 6 months

Pediatric dose: Clark’s rule
FRIED’S RULE
Adult Dose X (Weight ÷ 150) = Childs Dose
Younger than 1 year of age
Exercise #1

Adult dose = 500 mg every 8 hours

Body Surface Area (BSA)
Child’s weight = 46 lbs
BSA (m2) using west nomogram (inches and lbs
Exercise #2 or cm and kg) and square root (height in cm X
Adult dose = 500mg every 6 hours weight in kg)

Child’s weight = 31 kgs Pediatric dose:

CLARK’S RULE ALWAYS in POUNDS (lbs) Drug dose ordered x BSA using square root
(most precise).

Pediatric dose: Young’s rule

Adult Dose X (Age ÷ (Age+12)) = Child's Dose

Exercise #1

Adult dose = 500 mg every 8 hours

Child’s age = 10 y/o

Exercise #2

Adult dose = 500mg every 6 hours

Height (cms) and Weight in kgs
Child’s age = 7 y/o

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Example 1:  1 Kilogram= 1000 Grams
 1 Gram= 1000 Milligram
Desired dose = 100mg/m2
 1 Milligram= 1000 Micrograms
Height = 72cms Weight= 7 kgs  1 kg= 2.2 lbs
 1 lbs= 454 gm
Answer: 72 x 7 = 504/3600 = 0.14 = 0.37m2 x
 1 oz= 30 gm
100 mg = 37.41mg
 16 oz= 1 lb
Example 2:  1 inch = 2.54 cms (length)

Desired dose = 5mg/m2 Conversion of units

BSA - 1.5 m2 Two methods can be used:

Answer: 5mg / m2 x 1.5m2 = 7.5 mg 1. Dimensional analysis (D/A)

2. Ratio-Proportion calculation (R/P)

Dosage Conversion
NON-PARENTAL MEDICATIONS Method #1 : CONVERSION

1. Dosage calculation of solid form Dimensional Analysis

2. Dosage calculation of liquid form QUESTION: 0.6 g is how many milligrams?

X = conversion unit asked X Given dose

Conversion of units: volume basic equivalent value

 1cc= 1 mL Example:
 5mL= 1 tsp X = 1,000mg X .6 grams
 15mL= 1 tbsp
 30mL= 1 oz 1 gram
 480 mL= 1 pt X = 600 mg
 1 cup = 0.5 pint **
 3785 mL= 1 gal
 3 tsp= 1 tbsp Method #2: Ratio & proportion (R/P)
 2 tbsp= 1 oz
 1 tsp = 60 drops (gtts) QUESTION: 0.6 g is how many milligrams?
 16 oz= 1 pt given dose : X :: basic unit : basic equivalent
 2 pt= 1 qt
 4 qt= 1 gal given in unit asked
 1 grain = 64.8 mg .6 grams: _X_mg :: 1 gram : 1,000mg
 1 Liter= 1000 ml (metric)

TIPS:
Conversion of units: weight

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1. Know what is asked.

2. Know the doctor’s order = DESIRED

3. Know the available = STOCK

4. Know the CONVERSION UNITS

5. Know which method to use

6. Write LEGIBLY & NEATLY

7. Be careful in entering numbers

Conversion of dosage

Two methods can be used:

1. Basic Formula

→ Dimensional analysis (D/A)

2. Ratio-Proportion calculation (R/P)

→ Fractional Analysis

Sample problem:

A doctor orders 200 mg of Rocephin to be taken

by a 15.4 lb infant every 8 hours. The
medication label shows that 75-150 mg/kg per
day is the appropriate dosage range. Is this
doctor's order within the desired range?

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