Classroom Policies

Wear prescribed uniform and ID all the

time.
No book, no notebook, no paper, no
blue/black and red ball-pens means, NO
ENTRY!
Seating arrangement must be done
alphabetically
During quiz, DONT DO ANYTHING THAT I
MAY INTERPRET AS CHEATING
During group activities, make sure you
participate.
If absent, please secure excuse slip or
else , NO ENTRY!
Once inside, no going out until your break

Pharmacology
Darran Earl Gowing, RN,
MN

Have you wondered?

Why its usually okay to give children
Tylenol but not aspirin?
Why a lot of middle-aged and older
people take an aspirin a day?
Why people with high blood pressure,
heart failure, or diabetes take ACE
inhibitors and what ACE inhibitors are?
When an antibiotic should NOT be
prescribed for an infection?

Why Study Pharmacology?

A. To pass the requirement.
B. You will be able to use fancy terms
like Pharmacodynamics.
C. My instructor likes to torture people.
D. A competent nurse must understand
why his/her patient is getting a
medication, and HOW IT WORKS.

Purpose
The purpose of
studying
PHARMACOLOGY is to
help you learn about
medicines and the
WHY, WHAT, HOW,
WHEN, and WHERE
they are used in daily

Origin

BEFORE
of
Drugs
Drugs
were
mainly derived
from
Plants (eg,
morphine)
animals (eg,
insulin)
and minerals (eg,
iron)

ORIGIN
2700 BB earliest
recorded drug use
found in Middle East &
China
1550 BC Egyptians
created Ebers Medical
Papyrus

ORIGIN
Galen (131-201 AD) Roman
physician; initiated common
use of prescriptions
1240 AD introduction of
apothecary system (Arab
doctors)
1st set of drug standards &
measurements (grains,
drams, minims), currently
being phased out

ORIGIN
15th century
apothecary shops
owned by barber,
surgeons, physicians,
independent merchants
18th century small
pox vaccine (by Jenner)
Digitalis from foxglove
plant for strengthening
& slowing of heartbeat
Vitamin C from fruits

ORIGIN

19th century morphine &

codeine extract from
opium
Introduction of atropine &
iodine
Amyl nitrite used to relieve
anginal pain
Discovery of anesthetics
(ether, nitrous oxide)
Early 20th century
aspirin from salicylic acid
Introduction of
Phenobarbital, insulin,
sulforamides

ORIGIN

Mid 20th century

1940 Discovery
antibiotics (penicilline,
tetracycline,
streptomycin),
antihistamines,
cortisone
1950 discovery
antipsychotic drug,
antihypertensives, oral
contraceptives, polio
vaccine
Dr Albert Sabin, b.
1906, developer of the
oral live polio vaccine.

NOW
Synthetic
Semi-synthetic
Biotechnology

Knowing the terms!

Pharmacology
pharmacon - meaning drug
logos - meaning science
is the study of drugs (chemicals) that alter
functions of living organisms.

Drug therapy
also called pharmacotherapy, is the use of
drugs to prevent, diagnose, or treat signs,
symptoms, and disease processes.

Medication
Drugs given for therapeutic purposes.

Pharmacoeconomics
involves the costs of drug therapy,
including those of purchasing,
dispensing, storage, administration,
laboratory and other tests used to
monitor client responses, and losses
from expiration.
Drug
Any chemical that affects the physiologic
processes of a living organism

Drugs
Chemical name
Describes the drugs chemical
composition and molecular structure
Generic name (non-proprietary
name)
Name given by the country or
Adopted
Name Council
Trade name (proprietary name)
The drug has a registered trademark;

Drugs
Chemical name
(+/-)-2-(pisobutylphenyl)
propionic acid

Generic name
Ibuprofen

Trade name

Alaxan, Advil

Classification
Classification:
Functional Class vs. Chemical
Class
Medication classification
indicates:
effect of the medicine
symptom the medicine relieves
medicine desired effect (e.g. oral
hypoglycemics)

Classification
A medication
may also be
part of more
than one class
Aspirin is an
analgesic,
antipyretic,
antiinflammatory,

Medication
Forms
Medications
are
available in a
variety of forms
and preparations
The form of the
med will determine
its route of
administration
Composition of med
is designed to
enhance its
absorption &

Medication Forms
Tablet
Capsule
Caplet
Elixir
Enteric-coated
Suppository
Suspension

Transdermal
patch
Drops
Injections
Ointment
Tincture
Liniment
Aerosol

Tablets

Capsule

Caplet

ENTERIC COATED

Suspension

Subcutaneous Injection

Intramuscular or IM

Ointment

Elixir

Patch

Eye Drops or Eye

Ointment

Ear Drops

Tincture

Aerosol

Suppositories

Pharmacologic
Principles

Phases
Pharmaceutics
Pharmacokinetics
Pharmacodynamics
Pharmacotherapeutics
Pharmacognosy

PHASES OF DRUG ACTIVITY

Dose of
Formulated Drug(source: Mosbys Pharmacology for Nursing (2003
Administration

Disintegration of dosage
from dissolution of drug

PHARMACEUTICAL PHASE

Drug available for absorption

Absorption, distribution,
metabolism, excretion

PHARMACOKINETIC PHASE

Drug available for action

Drug-receptor
interaction
PHARMACODYNAMIC PHASE

EFFECT

Pharmaceutics
The study of how various drug
forms influence pharmacokinetic
and pharmacodynamic activities

Figure2-1 The chemical, generic, and trade names

for the common analgesic ibuprofen are listed next
to the chemical structure of the drug.

Drug Transport
What does this have
to do with drug
administration?
Drugs must reach
and interact with or
cross the cell
membrane to
stimulate or inhibit
cellular function

Pharmacokinetics
The study of what the body does to
the drug
Absorption
Distribution
Metabolism
Excretion
Remember:

ADME

Pharmacokinetics

Pharmacokinetics:
Absorption
The rate at which a drug leaves its
site of administration, and the
extent to which absorption occurs
Bioavailability
Bioequivalent

Factors That Affect

Absorption

Administration route of the drug

Ability of Medicine to Dissolve
Food or fluids administered with the drug
Body Surface Area
Status of the absorptive surface
Rate of blood flow to the small intestine
Lipid Solubility of Medicine
Status of GI motility

Factors Affecting
Pharmacokinetics
Age
Diseases
Individual
Differences
Psychological
Factors
Type & Amount of
Drug Prescribed

R
o
u
t
e
s

Oral
Pills, capsules,
tablets, liquids
SL, Buccal, NG,
Gastrostomy,
Duodenostomy
tubes
NOTE:
Assess clients
ability to take oral
medications

Oral

Dosage is determined
Drugs
by how much of the
drug is required to be
taken by mouth to
given the desired
affect.
Time in the stomach
is the stomach empty
full does it make a
difference on how drug
is absorbed
Small intestine large
surface area for
absorption of nutrients
and minerals

What else might influence

in stomach
oral drug Food
absorption?

Certain juices grapefruit

juice
Milk binds with
molecules of some drugs
so that the drug is never
absorbed
Orange juice enhances
absorption of iron taken
orally
The coating on the tablet:
chewable, enteric coated
(breakdown occurs in
small intestine), slow
release capsules

Intradermal Sites
Ventral
forearm
Upper chest
Shoulder

Subcutaneous Sites
Outer aspects
of the arms &
thighs
Hip & lower
abdomen
Above the iliac
crest

Intramuscular
Ventrogluteal
for 1 year and
above

Intramuscular
Vastus
lateralis
below 1 year
old

Intramuscular
Dorsogluteal - clients w/ welldeveloped gluteal

muscles

Intramuscular
Deltoid

Intravenous

(IV) is the installation of

fluid and/or
electrolytes, or
nutrient, medication
substances into a vein.

Topical Agent

skin, ophthalmic,
otic, nasal,
vaginal, rectal

Inhalation

Distribution
Transportation of drug
molecules within the
body
Drug needs to be
carried to the site of
the action
Need blood to circulate
the drug
Heart, liver, kidneys

Key Concepts
of drug
Protein binding
molecules need to get
Distribution

from the blood plasma

into the cell
Protein binding allows
part of the drug to be
stored and released as
needed
Some of the drug is
stored in muscle, fat
and other body tissues
and is gradually
released into the
plasma

Just how does the drug get

into the cell?

Drug must pass though

the capillary wall
Blood brain barrier
very effective in
keeping drugs from
getting into the central
nervous system or CNS
limits movement of
drug molecules into
brain tissue

Blood Brain Barrier

This is especially
important when
treating infections
of the brain such
as meningitis,
encephalitis, or
brain abscess
Medications must
be able to
penetrate the
blood brain barrier
Medications usually

Three ways to get in!

Direct penetration of the membrane
Protein channels
Carrier proteins

#1

Lipid Soluble Drugs

Lipid soluble drugs are able to dissolve in the

lipid layer of the cell membrane
No energy expended by the cell
Passive diffusion
Oral tablets or capsules must be water
soluble to dissolve in fluids of the stomach
and small intestine

#2

Protein Channels
Most drug molecules
are to big to pass in to
the cell via the
channels small ions
such as sodium and
potassium use the
protein channels but
their movement is
regulated by gating
mechanisms only
small amounts allowed

#3

Carrier Proteins
Molecule needs to bind
with a protein that will
transport it from one
side of the cell
membrane to another
a drugs structure
determines which
carrier will transfer it.

Metabolism
Method by which the drugs are inactivated or
biotransformed by the body
Active drugs contain metabolites that are
excreted skin, urine, stool
Most drugs metabolized in the liver by
cytochrome P450 (CYP)

What can stop this

process?
Enzyme inhibition
Other drugs
Combination drugs
Liver disease
Impaired blood circulation in person with
heart disease
Infant with immature livers
Malnourished people or those on lowprotein diets

An important concept!
First-pass effect some drugs are extensively
metabolized or broken down in the liver and
only a part of the drug is released into the
systemic circulation
This is why dosage is important how much
drug needs to be taken in to give the desired
effect and how often does it need to be taken

Excretion

Refers to the
elimination of the drug
from the body
Requires adequate
functioning of the
circulatory system and
organs of excretion
Kidneys
Bowels
Lungs
Skin

You are caring for a client who has diabetes

complicated by kidney disease. You will need to
make a detailed assessment when
administering medications because this client
may experience problems with:
A.
B.
C.
D.

Absorption
Biotransformation
Distribution
Excretion

Laboratory Values
Laboratory values reflecting function of liver
and kidneys need to be looked at.
BUN and Creatinine kidney function
Liver function tests:
ALT alamine aminotransferase
(elevated in hepatitis)
AST or SGOT aspartate
aminotransferase elevated in liver
disease
Bilirubin levels infants gallstones in
adults

Serum Drug Levels

Laboratory measurement of the amount of
drug in the blood at a particular time
A minimum effective concentration (MEC)
must be present before a drug exerts its
action on a cell.

Toxic Levels
Excessive level of a drug in the body
Single large dose
Repeated small doses
Slow metabolism which allows drug to
accumulate in the body
Slow excretion from the body by the
kidneys or gastrointestinal tract

Laboratory values are

important!
Serum drug levels indicate the onset, peak
and duration of the drug action

Do we do serum drug levels

for all drugs?
No
When do we need them?
Drugs with narrow margin of safety
(digoxin, aminoglycoside antibiotics,
lithium)
To check to see if the drug is at therapeutic
levels seizure medications
When drug overdose is suspected

Important concept!
Serum half-life or elimination half-life is the
time it takes the serum concentration of the
drug to reach 50%
A drug with a short half-life requires more
frequent administration
A drug with a long half-life requires less
frequent administration

Why is this important?

Half-life determines how often a drug is given
Daily in the morning
At bedtime
Q.I.D - four times a day
T.I.D three times a day
Q4 hours every four hours
Q 12 hours 9 am and 9 pm

Pharmacodynamics
The study of
what the drug
does to the
body the
mechanism of
drug actions in
living tissues
WHAT THE DRUG DOES TO THE BODY

Cellular Physiology
What does a cell do?
Exchange material
Obtain energy from
nutrients
Synthesize
hormones,
neurotransmitters,
enzymes, structural
proteins and other
complex molecules
Duplicate themselves

Pharmacodynamics
Drugs can:
1.Inhibit
2.Activate
3.Replace

Enzyme Interaction
Enzymes are substances that catalyze nearly
every biochemical reaction in a cell
Drugs can interact with enzyme systems to
alter a response
Inhibits action of enzymes-enzyme is
fooled into binding to drug instead of
target cell
Protects target cell from enzymes action
(ACE Inhibitors)

Receptor theory
Most drugs exert their
effects by chemically
biding with receptors
at the cellular level.
Receptors are
proteins located
on the surfaces of cell
membranes
within the cells

What do the RECEPTORS

do?
The receptors are often
described as the lock
into which the drug
molecule fits as a key.
All body cells do not
respond to all drugs
even when all the cells
are exposed to the
drug.

RECEPTOR

LOCKS

KEYS

Pharmacodynamics
Receptors are
regulated in TWO
WAYS:
1.Agonists
(activators)
bind to the
receptor and act to
produce a
pharmacologic
effect
2.Antagonists
(blockers)

Agonist-Antagonist

More is not better!

Number of receptors
site available will effect
drug action so giving a
higher dose does not
necessarily produce
additional
pharmacological
effects.

Drug Dosing

Often the first dose is

higher in an effort to
bring the therapeutic
blood serum levels up
quicker

Drug Diet interaction

Food can slow
absorption
Food substances can
react with certain drugs
How to give medication
is information provided
in you drug manual

Drug Drug Interaction

Some drugs taken together will enhance
each other
Tylenol with codeine
Some drugs taken together will interfere with
another drugs actions
Some drugs are given to decrease or reverse
the toxic effects of a drug
Narcotic antidote is naloxone

Drug Tolerance

Body becomes
accustomed to drug
over period of time

Adverse Effects
Undesired response
Allergic reaction
Drowsiness
Nausea / vomiting / GI upset
Liver or kidney damage
Fevers
Drug dependency
Cancinogenicity ability to cause cancer
Teratogenicity cause damage to fetus

Pharmacotherapeutics

The use of
drugs and the
clinical
indications for
drugs to prevent
and treat
diseases

The effectiveness of
Monitoring
the drug therapy
must be evaluated.
One must be
familiar with the
drugs intended
therapeutic action
(beneficial) and the
drugs unintended
but potential side
effects (predictable,
adverse drug
reactions).

Types of Therapies
Acute therapy
Maintenance
therapy
Supplemental
therapy
Palliative therapy
Supportive
therapy
Prophylactic
therapy

Type of Medication Action

Therapeutic Effect
Side Effects
Adverse Effects
Toxic Effect
Idiosyncratic
Reactions
Allergic Reaction
Medication
Interactions
Iatrogenic Response

Therapeutic Effect
The expected or
predictable
physiological
response a
medication
causes
A single med can
have several
therapeutic
effects

Side Effects
Unintended secondary
A drug that
does not
cause sideeffects is a
drug that
does not
work.

effects a medication
predictably will cause
May be harmless or
serious
If side effects are serious
enough to negate the
beneficial effect of meds
therapeutic action, it
may be D/C
People may stop taking
medications because of
the side effects

ADVERSE RECTION
Medication misadventures
Adverse drug events
Adverse drug reactions
Medication errors

Adverse Effects
Undesirable response

of a medication
Unexpected effects of
drug not related to
therapeutic effect
Must be reported to
FDA
Can be a side effect or
a harmful effect
Can be categorized as
pharmacologic,
idiosyncratic,
hypersensitivity, or
drug interaction

Toxic effect
Toxicology
The study of
poisons and
unwanted
responses to
therapeutic agents

Toxic Effect

May develop after

prolonged intake or
when a medicine
accumulates in the
blood because of
impaired metabolism or
excretion, or excessive
amount taken
Toxic levels of opioids
can cause respiratory
depression
Antidotes available to
reverse effects

Table2-9 Common
Poisons and
Antidotes

Idiosyncratic Reactions
Unpredictable
effects-overreacts or
under reacts to a
medication or has a
reaction different
from normal
Normal effect is
produce by a small
fraction of the
standard dose.

Allergic Reaction

Unpredictable response
to a medication
Makes up greater than
10% of all medication
reactions
Client may become
sensitized
immunologically to the
initial dose, repeated
administration causes
an allergic response to
the medicine, chemical
preservative or a
metabolite

Allergic Reaction
Medication
acts as an
antigen
triggering the
release of the
bodys
antibodies
May be mild or
severe

A postoperative client is receiving

morphine sulfate via a PCA. The
nurse assesses that the clients
respirations are depressed. The
effects of the morphine sulfate can
be classified as:
A. Allergic
B. Idiosyncratic
C. Therapeutic
D. Toxic

35 - 114

Other Drug Reactions

TeratogenicStructural effect in
unborn fetus
CarcinogenicCauses cancer
MutagenicChanges genetic
composition
(radiation,
chemicals)

Iatrogenic Responses
Unintentional adverse effects that
occur during therapy
Treatment Induced Dermatologic
rash, hives, acne
Renal Damage
Aminoglycoside antibiotics, NSAIDS,
contrast medium
Blood Dyscrasias
Destruction of blood cells
(Chemotherapy)
Hepatic Toxicity
Elevated liver enzymes

DRUG INTERACTIONS
Interactions
Additive effect
Synergistic effect
Antagonistic
effect
Incompatibility

Drugs are said to

have
an additive
ADDITIVE
EFFECT
effect when they
have similar actions.
Lower doses are
needed when the
drugs are given
together.
Similar therapeutic
activity can cause
problems if
administered
together

Synergistic Effect
Effect of 2 meds
combined is greater
than the meds given
separately
Alcohol &
Antihistamines,
antidepressants,
barbiturates,
narcotics

ANTAGONIST EFFECT
Combined effect is
less than each of
them alone.
Drugs with opposite
action to that of
another drug or
natural body
chemical
Examples: Betablockers the olol
drugs

INCOMPATIBILITY
EFFECT
Drugs are
incompatible when
combining them
causes chemical
deterioration of one
or both

NURSING
RESPONSIBILITY

The
Nursing
Process

The Nursing Process

Assessment
Data collection
Subjective, objective
Data collected on the patient, drug,
environment

Medication history
Nursing assessment
Physical assessment
Data analysis

Constant
System
A double-check

The
entire
system
Analysis
of medication
administration
Ordering,
dispensing,
preparing,
administering,
documenting
Involves the
physician, nurse,
nursing unit,
pharmacy
department, and

Administering 1. Right Patient

2. Right Medication
Medications 3. Right Dosage
4. Right Route
5. Right Time
6. Right
Documentation
7. Right Client
Education
8. Right to Refuse
9. Right Assessment
10. Right Evaluation

Other Rights
Proper drug storage
Careful checking of
transcription of orders
Patient safety
Close consideration of
special situations
Prevention and
reporting of medication
errors
Monitoring for
therapeutic effects, side
effects, toxic effects

Evaluation

Ongoing part of
the nursing
process
Determining the
status of the goals
and
outcomes of care
Monitoring the
patients response
to drug therapy

Questions???
The day shift charge nurse is making rounds.
A patient tells the nurse that the night shift
nurse never gave him his medication, which
was due at 11 PM. What should the nurse do
first to determine whether the medication
was given?
1.Call the night nurse at home.
2.Check the Medication sheet.
3.Call the pharmacy.
4.Review the nurses notes.

Questions???
The patients Medication sheet lists two
antiepileptic medications that are due at 0900,
but the patient is NPO for a barium study. The
nurses coworker suggests giving the
medications via IV because the patient is NPO.
What should the nurse do?
1.Give the medications PO with a small sip
of water.
2.Give the medications via the IV route
because the patient is NPO.
3.Hold the medications until after the test is

Know your drug

Clients expect you to be knowledgeable
You gain this knowledge be looking up
medications
Drug hand book
PDA
Pharmacist

Legal Responsibilities
The nurse is responsible for
safe and accurate administration
having sufficient drug knowledge to
recognize and question erroneous
orders
actions delegated to other persons
orderly cannot give medications
monitor clients response to a
medication
following safe practices the ten

Medication Systems
Each facility has a
system for
administering
medication
Be familiar with this
process & need to
learn at each new
facility
Basics of medication
administration

Medication Orders
Full name of client
Generic or trade name of drug
Dose, route, frequency
Date, time and signature of provider
The nurse will need to look up the
medication ordered to know its
classification, safe dose, action, how to
administer, and side effects
The nurse should know why the
medication is ordered

LIFE SPAN
CONSIDERATIONS

Life Span Considerations

Pregnancy
Breast-feeding
Neonatal
Pediatric
Geriatric

Pregnancy
First trimester is the
period of greatest
danger for druginduced developmental
defects
Drugs diffuse across
the placenta
FDA pregnancy safety
categories

PREGNANCY
CLASSIFICATION
Class A

Studies failed to
demonstrate fetal
anomalies.

Class B
Animal studies have
not demonstrated a
fetal risk.
Information in human
is not available

PREGNANCY
Class C
CLASSIFICATION
Studies in animal have
revealed an adverse
effect

Class D
There is a positive
evidence of fetal risk
but in some cases may
warrant the use of
these drugs

Class X
Studies in animal and
human have revealed

Breast-feeding
Breast-fed infants are
at risk for exposure to
drugs consumed by the
mother
Consider risk-to-benefit
ratio

Table 3-2 Classification

of young patients

Pediatric Considerations: Pharmacokinetics

Absorption
Gastric pH less acidic
Gastric emptying is
slowed
Topical absorption
faster through the
skin
Intramuscular
absorption faster and
irregular

Pediatric Considerations
Distribution

TBW 70% to 80% in

full-term infants, 85%
in premature newborns,
64% in children 1 to 12
years of age
Greater TBW means fat
content is lower
Decreased level of
protein binding
Immature blood-brain
barrier

 Metabolism

Pediatric Considerations

Liver immature,
does not produce
enough
microsomal
enzymes
Older children
may have
increased
metabolism,
requiring higher
doses

Pediatric Consideration
Excretion
Kidney immaturity
affects glomerular
filtration rate and
tubular secretion
Decreased perfusion
rate of the kidneys

Summary of Pediatric
Considerations
Skin is thin and permeable
Stomach lacks acid to kill bacteria
Lungs lack mucus barriers
Body temperatures poorly regulated
and dehydration occurs easily
Liver and kidneys are immature,
impairing drug metabolism and
excretion

Methods of Dosage Calculation for Pediatric

Patients

Body weight dosage

calculations
Body surface area
method

Geriatric Considerations
Geriatric:
older than age 65
Healthy People
2010: older than
age 55

Use of OTC
medications
Polypharmacy

Geriatric Considerations:
Pharmacokinetics
Absorption

Gastric pH less acidic

Slowed gastric
emptying
Movement through
GI tract slower
Reduced blood flow
to the GI tract
Reduced absorptive
surface area due to
flattened intestinal
villi

Geriatric Considerations
Distribution
TBW percentages
lower
Fat content increased
Decreased
production of
proteins by the liver,
resulting in
decreased protein
binding of drugs

Geriatric Considerations
Metabolism
Aging liver
produces less
microsomal
enzymes, affecting
drug metabolism
Reduced blood
flow to the liver

Geriatric Considerations
Excretion
Decreased
glomerular
filtration rate
Decreased
number of intact
nephrons

Geriatric Considerations

Analgesics
Anticoagulants
Anticholinergics
Antihypertensives
Digoxin
Sedatives and
hypnotics
Thiazide diuretics

MEDICATION ERRORS:
PREVENTING &
RESPONDING

Medication Misadventures
By definition, all ADRs
are also ADEs
But all ADEs are not
ADRs
Two types of ADRs
Allergic reactions
Idiosyncratic reactions

Medication Errors
Preventable
Common cause of
adverse health
care outcomes
Effects can range
from no significant
effect to directly
causing disability
or death

Common classes of medications

involved in serious errors

Preventing

Minimize verbal or
Medication
Errors
telephone orders
Repeat order to
prescriber
Spell drug name
aloud
Speak slowly and
clearly

List indication next

to each order
Avoid medical
shorthand, including
abbreviations and
acronyms

Preventing Medication

Never assume anything

about items not
specified in a drug
order (i.e., route)
Do not hesitate to
question a medication
order for any reason
when in doubt
Do not try to decipher
illegibly written orders;
contact prescriber for
clarification

Preventing Medication
NEVER use
trailing zeros
with medication
orders
Do not use 1.0
mg; use 1 mg
1.0 mg could be
misread as 10
mg, resulting in a
tenfold dose

ALWAYS use a
leading zero for
decimal dosages
Do not use .25
mg; use 0.25 mg
.25 mg may be
misread as 25 mg
.25 is
sometimes called
a naked
decimal

Preventing Medication

Check medication
order and what is
available while using
the 10 rights
Take time to learn
special
administration
techniques of
certain dosage
forms

Preventing Medication Errors (cont'd)

Always listen to and

honor any concerns
expressed by
patients regarding
medications
Check patient
allergies and
identification

Nurses are legally required to document

medications that are administered to
clients. The nurse is mandated to
document:
A. Medication before
administering it
B. Medication after administering
it
C. Rationale for administering
the medication
35 - 166

If a nurse experiences a problem

reading a physicians medication
order, the most appropriate action
will be to:
A. Call the physician to verify
the order.
B. Call the pharmacist to verify
the order.
C. Consult with other nursing
35 - 167

METRIC SYSTEM

Metric System
Meter is used for
linear measure,
gram for weight
and liter for
volume

Apothecary System
Grains, minims,
drams, ounces,
pounds, pints, and
quarts

Household measures

Drops, teaspoons,
tablespoons and cups
Important since this is
often how people take
medications

Units
mEq drugs
ordered in
number of units
per dose
Insulin
heparin

Milliliters
mL = milliliter.
This is a
VOLUME
measurement. it
is 1/1000 of a
liter. when
talking about
water or similar
liquids, it is
equivalent to
one cubic
centimeter.

Cubic Centimeter
cc = cubic
centimeter. This
is also a
VOLUME
measurement.
Most syringes
measure their
capacity in cc's.
If you have a
5cc syringe, it
will hold ~5mL
of liquid in it.

mL and ccs
1 mL = 1cc
1 cc = 15 to 16 minims
1 cc = 15 to 16 drops

Fluids are generally

written in ccs to
standardize the
abbreviation you may
see mLs written but
this abbreviation is
being eliminated

ccs and household

measures

5 cc = 1 tsp (teaspoon)
15 cc = 1 tbs (tablespoon)
30 cc = 1 oz (ounce) = 2
tablespoons
240 cc = 8 oz or 1 cup

Milligrams
mg = milligram. This is a WEIGHT
measurement. It is 1/1000 of a gram. the
amount of chemical substance is often
measured in milligrams. For injectable
solutions, this will be reported as a
concentration of weight to volume, such as
mg/ml (milligrams per milliliter).

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