FACTORS AFFECTING DRUG ACTION RELATING THE NURSING PROCESS TO

 Age PHARMACOLOGY
 Body weight FOR ASSESSMENT: TAKING THE DRUG
HISTORY. This is important because:
 Metabolic rate
 It evaluates the patient’s need/s for medications
 Illness
 It obtains the patient’s current and past use of
 Psychological aspect OTC, prescription, herbal products, and street drugs
 Tolerance  It identifies problems related to drug therapy
 Dependence  It elicits subjective and objective data, including
information from secondary and tertiary sources
DRUG EVALUATION
FOR PROBLEM IDENTIFICATION: NURSING
 Preclinical Trials
DIAGNOSIS. This is valuable because:
Chemicals tested on laboratory animals
 It allows the nurse to recognize etiologic and
 Phase I Studies contributing factors – which refer to clinical and
personal situations that can cause the problem or
Chemicals tested on human volunteers influence its development
 Phase II Studies FOR PLANNING: With reference to the prescribed
medications, it must include the ff steps:
Drug tried on informed patients with the disease
 Identification of the therapeutic client for each
 Phase III Studies prescribed medication (Why was the drug
Drug used in vast clinical market prescribed? What symptoms should be relieved?)
 Phase IV Studies  Identification of side-effects to expect
Continual evaluation of the drug  Identification of the recommended dosage and
DRUG INTERACTION route of administration

This is said to occur when the action of one drug is  Scheduling of drug administration based on
altered by the action of another drug. It is elicited in doctor’s orders
two ways:  Teaching the patient to keep a record of responses
1. Agents that when combined increase the actions of to the prescribed medications
one or both drugs FOR IMPLEMENTATION/NURSING
2. Agents that when combined decrease the INTERVENTIONS: Dependent and Independent
effectiveness of one or both drugs Nursing Actions

TERMS DESCRIBING DRUG INTERACTIONS: FOR DEPENDENT NURSING ACTIONS

 Additive effect – 2 drugs with similar actions are  Nurse prepares and administers drug based on
taken for a doubled effect physician’s orders

 Synergistic effect –An interaction between two or  Nurse stops drug administration for any untoward
more drugs that causes the total effect of the drugs to symptoms as ordered by doctor
be greater than the sum of the individual effects of INDEPENDENT NURSING ACTIONS:
each drug.
 Nurse visits the patient and obtain
 Antagonistic effect – one drug interferes with the nursing/medication hx
action of the other
 Nurse verifies drug order and assumes
 Displacement – displacement of a drug by the 2nd responsibility for correct transcription
drug increases the activity of the 1st drug
 Nurse makes professional judgments concerning
 Interference – one drug inhibits the all drug aspects
metabolism/activity of the second drug, causing
increased activity of the second drug FOR EVALUATION:
 Incompatibility – one drug is chemically - Assesses response to the medications prescribed,
incompatible with another drug, causing deterioration such as observation of signs and symptoms of
when the 2 drugs are mixed in the same syringe or recurrent illnesses or development of side-effects
solution
- It also includes the determination of the patient’s
perform self-administration of drugs
ability to receive patient education and perform self-  gtts/min – drops per minute or macrodrops per
administration of drugs minute (used for adults/macroset IV lines)
- This should also encompass the patient’s potential  ngtts/min – microdrops per minute (commonly
for compliance used for pediatric patients/microset IV lines)
PRINCIPLES OF MEDICATION COMMONLY-USED DRUG FORMULAS
ADMINISTRATION
 FOR IV FLOW RATES
 6 RIGHTS OF DRUG ADMINISTRATION
1. If looking for cc (ml) per hour: volume of
1. Right drug fluid/number of hours = no. of cc/hr
2. Right time 2. If looking for hours to consume: volume of fluid
x drop factor/ gtts/min x 60 = no. of hours
3. Right dose
3. If looking for drops OR ngtts per minute:
4. Right patient volume of fluid x drop factor /no. of hours x 60=
gtts/minute OR ngtts/minute
5. Right route
 FOR IV INJECTIONS:
6. Right documentation
D/S x Q
REMINDERS PRIOR TO DRUG
D = Dosage
ADMINISTRATION
S = Stock
 Check:
Q = Quantity
- the label of the container for drug name,
concentration, and route of appropriate administration ENTERAL ADMINISTRATION OF DRUGS
- the patient’s chart  These preparations enter the GI tract and are
absorbed more slowly into the bloodstream than via
- the medications to be mixed in one syringe
any other route.
- the patient’s identity ALL THE TIME
 The slow absorption rate makes the PO (by mouth)
 Do: route relatively safe.

- Approach the patient in a kind but firm manner  Some PO medications are irritating to the patient’s
GI tract, and larger tablets may be difficult for some
- Adjust the patient to the most appropriate position patients to swallow.
for the route of administration
DOSAGE FORMS – ENTERAL
- Remain with the patient to ensure that all
medications have been swallowed  CAPSULES

- Health education - Small, cylindrical gelatin containers that hold dry

powder or liquid medicinal agents
- NOT administer a drug which is not properly
labeled or from a container where the label is not - They do not require coatings or additives to improve
legible taste

TYPES OF MEDICATION ORDERS TIME-RELEASE OR SUSTAINED RELEASE

 Stat order – it means that the drug should be CAPSULES – provide a gradual but continuous
administered ASAP but ONLY once. release of a drug because the granules within the
capsule dissolve at different rates
 Standing order – it means that a drug is to be
administered continuously until discontinued at a  LOZENGES – flat disks containing a medicinal
later date agent in a suitably flavored base.

 PRN order – means “administer if needed”  PILLS – refer to both tablets and capsules

 Verbal orders  TABLETS – dried that have been compressed into

small disks. It can be enteric-coated or not. It contains
 Electronic transmission of patient’s orders one or more of the ff ingredients:
Nurses’ responsibilities include verification and a. Binders – adhesive substances that allow the tablet
transcription to stick together
DOSAGE CALCULATIONS b. Disintegrators – encourages dissolution in body
fluids
UNITS OF MEASUREMENTS (FOR IV FLOW
RATE) c. Lubricants – needed for efficient manufacturing
d. Fillers – makes the tablet size convenient medications per orem.

EMULSIONS COMMONLY-USED MEASUREMENT

- Dispersions of small droplets of water-in oil or oil- EQUIVALENTS

in water. Dispersion is maintained by emulsifying
HOUSEHOLD APOTHECARY METRIC
agents such as: (1) sodium lauryl sulfate, (2) gelatin, MEASUREMENTS MEASUREMENTS MEASUREMENTS
or (3) acacia. 2 tbsp 1 oz 30 ml
- It masks bitter tastes and provide better solubility to 1 tbsp 1⁄2 oz 15 ml
certain drugs. 2 tsp 1/3 oz 10 ml
1 tsp 1/6 oz 5 ml
 ELIXIRS SUPPOSITORIES
- Clear liquids made up of drugs dissolved in alcohol  Cone-shaped, egg-shaped, or spindle-shaped
and water. medication made for insertion into the rectum or
vagina
- Used primarily when the drug will not dissolve in
water alone.  Dissolves at body temperature and absorbed
directly into the bloodstream
- After the drug is dissolved in the elixir, flavoring
agents are added to improve taste  Useful for infants, patients who cannot take oral
preparations, and patients with nausea and vomiting
 SYRUPS
 Stored in cool place so they do not melt
- Medicinal agents dissolved in a concentrated
solution of sugar, usually sucrose. GENERAL FORMS OF SOLID-FORM
- Commonly used for pediatric patients, because of its MEDICATION ADMINISTRATION
effectiveness in masking bitter taste of drugs.
 Give the most important medication first
 SUSPENSIONS
 Allow the patient to drink a small amount of water
- Liquid dose forms that contain solid, insoluble to moisten the mouth and make
particles dispersed in a liquid base.
swallowing of the medication easier
- All suspensions should be shaken well before
administration to ensure thorough mixing of particles.  Have the patient place the medication well on the
back of the tongue.
MEDICINAL EQUIPMENTS
 Give the patient liquid to swallow medication.
 SOUFFLE CUPS – small paper or plastic cups Encourage keeping the head forward while
that may be used to transport solid medications (such swallowing.
as capsule or tablet) to prevent contamination by
handling.  Drink a full glass of liquid to ensure that
medication reaches the stomach to dilute the drug and
 MEDICINE CUPS decrease potential for irritation
- glass or plastic container with 3 scales: apothecary,  Always remain with the patient while the
household, and metric used for the measurement of medication is taken. DO NOT leave the medication
liquid medications on the bedside unless an order exists to do so (e.g.,
Nitroglycerin)
- It is not reliable when measuring doses of less than
a teaspoon but reasonably accurate for larger volumes  Discard the medication container.
 ORAL SYRINGE GENERAL FORMS OF LIQUID-FORM ORAL
- Used in measuring liquid medications accurately MEDICATION ADMINISTRATION
- Various sizes are available to measure volumes  Give the most important medication first
from 0.1 to 15 ml.
 Never dilute a liquid medication unless specifically
 NIPPLE ordered to do so.
- An infant feeding nipple with additional holes used  Always remain with the patient while the
in administering oral medications to infants medication is taken. DO NOT leave the medication
on the bedside unless an order exists to do so
 MEDICINE DROPPER
DRUG ACTIONS
- Used in administering eye drops, ear drops, and
occasionally, pediatric medications  Desired action – the drug’s expected response
 TEASPOON  Side-effects/adverse effects – affects more than
one body system
- Commonly used for administering liquid
medications per orem.
 Idiosyncratic reaction – occurs when something
unusual or abnormal happens when a drug is first
administered; due to patient’s inability to metabolize
drugs
 Allergic reactions – “hypersensitivity”; occur in
patients who have previously been exposed to a drug
and have developed antibodies to it
FACTORS AFFECTING DRUG ACTION
Types
 Age
 Tuberculin syringe
 Body weight
 Insulin syringe
 Metabolic rate
 Three-milliliter syringe
 Illness
 Safety-Lok syringes
 Psychological aspect
 Disposable injection units
 Tolerance
 Dependence
 Cumulative effect
DOCUMENTATION –THE 6TH RIGHT
 Chart the date, time, drug name, dose and route of
administration.
 Perform and record for regular patient assessments
to evaluate therapeutic effectiveness
 Chart any signs and symptoms of adverse drug
effects.
 Perform and validate essential patient education
about the drug therapy.
 If patient is on NGT, chart the verification of NG
SAFE ADMINISTRATION OF PARENTERAL
tube placement, including all fluids administered
MEDICATIONS
TUBAL MEDICATIONS
 It is essential that nurses preparing medications
 Nasogastric (NG) tubes are used to administer
focus on:
liquid medications to unconscious patients, dysphagic
patients, and those who are too ill to eat. 1. The basic knowledge needed regarding the
individual drugs being ordered, prepared, and
 Many medications come in liquid form; if they do
administered.
not, solid tablets may be pulverized in a mortar and
pestle, and capsules can be opened. 2. Symptoms for which the medication is prescribed,
and collection of baseline data to be used for
 Not all tablets are safe to use when crushed, and
evaluation of therapeutic outcomes
not all capsules are safe to use when opened.
3. Nursing assessments needed to detect, prevent, or
SYRINGES
ameliorate adverse effects
 Parts of the syringes
4. Exercising clinical judgments about scheduling of
- Barrel (place of calibration) new drug orders, missed dosages, modified drug
orders or substitution of therapeutically- equivalent
- Plunger (used for ejection and drawing up of medicines by the pharmacy
solutions)
NEEDLES
- Needle (used to penetrate the medication container)
 Common IV needle colors and gauges
Prefilled syringes – with a premeasured amount of
medication in a disposable cartridge-needle unit; - Gauge 18 –Green
called by Brand Names.
- Gauge 20 – Pink
 Outside of the barrel is calibrated in milliliters,
- Gauge 22 – Blue
minims, insulin units, and heparin units.
- Gauge 24 –Yellow
- Gauge 26 -Violet subcutaneous tissue
 Parts of the Needle  Usual needle length is 1/2 to 5/8 inch and 25 gauge
- Bevel/Beveled Tip (sharp, pointed tip)  Used to administer insulin and heparin
- Shaft (tubular body of the needle) PERCUTANEOUS ADMINISTRATION OF
- Hub (base of the needle) MEDICATIONS
DOSAGE FORMS – PARENTERAL  With these routes, medications are absorbed
through the skin or the mucous membranes.
 Ampules – glass containers that usually contain a
single dose of medication. It has a darkened ring  Most produce a local action, but some produce a
around the neck, - a marker at which the ampule is systemic action.
broken open
 Drugs include topical applications, instillations, and
 Vials – glass containers with one or more doses of inhalations and ointments, creams, powders, lotions,
sterile medication. and transdermal patches.
 Mix-O Vials – glass containers with 2  Absorption is rapid but of short duration.
compartments; lower chamber contains the drug
(solute), and the upper chamber contains the sterile DRUGS ADMINISTERED PERCUTANEOUSLY
diluent
 Ointments
 Intramuscular Injections
 An oil-based semisolid medication; may be
Involves inserting a needle into the muscle tissue to applied to the skin or a mucous membrane
administer medication
 Creams
 Site Selection
 Semisolid, non-greasy emulsions that contain
 Gluteal sites medication for external application

 Vastus lateralis muscle  Lotions

 Rectus femoris muscle  Aqueous preparations that are used as soothing

agents that relieve pruritus, protect the skin, cleanse
 Deltoid muscle the skin, or act as astringents
 Z-track Method  Transdermal Patches (Topical Disk)
 Used to inject medications that are irritating to the Adhesive-backed medicated patches applied to the
tissues skin provide sustained, continuous release of
medication over several hours or days.
 Intradermal Injections
 Eyedrops and Eye Ointments
Introduction of a hypodermic needle into the
Care should be taken to keep all ophthalmic
dermis for the purpose of instilling a preparations sterile by not
substance such as a serum, vaccine, or skin touching the dropper or the tube to the eye.
test agent  Eardrops
 Not aspirated Containers of solutions to be used as eardrops will be
labeled “otic.” They must be at room temperature
 Small volumes (0.1 ml) injected to form a small
when applied.
bubblelike wheal just under the skin
 Nosedrops
 Used for allergy sensitivity tests, TB screening, and
local anesthetics Nosedrops are for individual use only.
 A tuberculin syringe used with a 25-gauge,  Nasal Sprays
3/8- to 5/8-inch needle Sprays absorbed quickly; less medication is used and
wasted whenadministered in this manner.
 Subcutaneous Injections
 Inhalation
Injections made into the loose connective tissue
between the dermis and the muscle layer Drugs may be absorbed through the mucous
membranes of the respiratory tract.
 Drug absorption slower than with IM injections
Inhalation produces a relatively limited effect or a
 Given at a 45-degree angle if the patient is thin or at
systemic effect.
a 90-degree angle if the patient has ample
subcutaneous tissue
  This method is actively used by respiratory therapy receptor but inhibits other responses
and anesthesiologists.
MODULE 1 THREE CATEGORIES OF DRUG
 Sublingual Administration ADMINISTRATION
PHARMACOLOGY
Drug is administered by placing it beneath the tongue  Enteral – administered directly into the GI tract by
-until
Came from the Greek word “pharmakon” (drugs)
it dissolves. oral, rectal, or nasogastric routes.
and “logos” (study)
Drug may be a tablet or liquid squeezed out of a  Parenteral – bypass the GI tract through (SC)
-capsule.
deals with the study of drugs and their actions on subcutaneous, (IM) intramuscular, or intravenous
living organisms injection
It is rapidly absorbed into the bloodstream.
THERAPEUTIC METHODS  Percutaneous – done through inhalation,
 BuccalAdministration sublingual or topical administration.
These are the therapeutic approaches done to treat
A tablet is placed between the cheek and teeth, or WHAT HAPPENS TO THE DRUG AFTER
diseases/illnesses. Examples include:
between the cheek and the gums.
ADMINISTRATION?
 Drug therapy
Absorption – treatment
into the capillarieswith drugs
of the mucous
membranes of the cheek gives rapid onset of the 1. Absorption – the process by which the drug is
 Diet therapy – treatment by diet transferred from the site of entry to the circulating
drug’s active ingredient.
fluids (blood and lymphatic system) of the body.
 Physiotherapy – treatment with natural physical
forces such as water, light, and heat Factors affecting the rate of absorption:

 Psychological therapy – identification of stressors a. Blood flow through the tissue where the drug is
and methods to reduce or eliminate stress and/or the administered
use of drugs b. Drug solubility
DRUGS 2. Distribution – ways in which drugs are transported
by circulating body fluids to the sites of action,
o These are chemical substances with a metabolism, and excretion
substantive effect on living organisms.
3. Metabolism – also called “biotransformation”. It is
o When drugs are therapeutic, they are termed as
the process by which the body inactivates the drugs
MEDICINES. (the Liver is the primary organ)
DRUG NAMES 4. Excretion – elimination of metabolites of drugs
(the Kidney is the primary organ)
Chemical name – pertains to the chemical
constitution of the drug, such as its exact atomic OTHER RELATED TERMS:
placement and molecular groupings
Half-life – the amount of time required for 50% of the
Generic name (nonproprietary names) - the common drug to be eliminated from the body
or general name of a particular drug Carcinogenicity – the ability of the drug to induce
living cells to mutate and become cancerous
Official name – the name under which the drug is
listed in the US FDA Placebo – a drug dosage form such as a capsule or
tablet that has no pharmacologic activity because the
Trademark (Brand name) – this is followed by the dosage form has no active ingredients
symbol ®. This indicates that the name is registered
Tolerance – occurs when a person begins to require
and that its use is restricted to the drug higher doses to produce the same effects that lower
owner/manufacturer. doses once provided
HOW DO DRUGS ACT ON THE BODY? DRUG ACTIONS

o Drugs do not create new responses but alter the Desired action – the drug’s expected response
existing physiologic activity.
Side-effects/adverse effects – affects more than one
o It interacts with the body by forming chemical body system simultaneously; undesired.
bonds with specific sites called RECEPTORS.
o The intensity of the drug response is also Idiosyncratic reaction – occurs when something
unusual or abnormal happens when a drug is first
related to the number of receptor sites
administered; due to the patient’s inability to
occupied. metabolize drugs
 Agonists – drugs that interact with a receptor to Allergic reactions – “hypersensitivity”; occurs in
produce a particular response patients who have previously been exposed to a drug
and have developed antibodies to it
 Antagonists – drugs that attach to the receptor
but do not stimulate a response

 Partial Agonists – drugs that interact with a