• PHARMACOLOGY

• (ANTONIO B. CRUEL, RMT, RN, MSPH)

• PHARMACODYNAMICS:
• what drugs do to the body
• Drug Effects:
• 1. DESIRED =therapeutic effect
• 2.SIDE = unintended/predictable
• 3. ADVERSE = harmful/severe
• 4. TOXIC= pathologic/> 1st drug
• 5. IDIOSYNCRATIC=unpredictable
• 6. CUMULATIVE=> response RT repeated
dose,<metab,<excretion
• ALLERGIC= drug: Ag
• ANAPHYLAXIS= > allergic rxn: bronchial
vc, LE causing airway obstruction
• TOLERANCE= <effect RT rpt dose; reqr >
• TACHYPHYLAXIS= rapid devt of
tolerance to drug
• DEPENDENCE=driving needs: drug use
• *HABITUATION: PSYCH
• *PHYSICAL: ADDICTION
• ABUSE= inappropriate drug intake
(un/prohibited)
• DRUG INTERACTION=mod of drug
effect:
ANTAGONISM= opposing 1 + (-1)=0
SUMMATION= combined(=) 1 + 1= 2
SYNERGISM= combined(>) 1 + 1= 3
POTENTIATION= 1 drug enhanced by etc.
1 drug alone (0)
1 + 1= 1x,2x,3x effect
PHARMACOKINETICS= body does to drugs
2. ABSORPTION
=site of admin to bloodstream
>in: IV, >absorbing surface, liquid/lipid soluble
form, good blood flow
<in: PO (RT food, >GI motility, acid pH
2. DISTRIBUTION
=from site of absorption to action
>in: >BF, >PPB (drugs inactive if bound in
albumin for transport), >volume of
distribution (edema), > membrane perm.
<in: <albuminemia(<PPB=>free drug), dehydr
• METABOLISM
• =chemical events (in/activates drug)
• *Biotransformation=using enz, drugs are
made more H20-soluble (excreted in liver)
• *1st-pass effect= oral meds are metab in
liver via portal circ before distributed
• >in: Drug-drug interaction (>Cytochrome
P450)
• <in: infants, elderly, disease (liver, malnut)
• ELIMINATION/EXCRETION
• =excreted via kidnys, intestines, bile duct,
lungs, sweat, mammary glands
• =affected by DD interaction, organ elim,
blood% levels, renal status.
• Renal excretion= filtration+secretion=reab
• <renal fxn=<excretion=>toxicity
• Excretes only H20-sol,unbound metabolite
• Modified by acid/alkalinizing urine
• (carbonic anhydrase inh alkalizes urine >
UA excretion)
• DRUG ADMINISTRATION
• Principles:
• 1. 7 Rights: DR. CAT
– *DRUG
– *DOSE
– *ROUTE
– *RECORD
– *CLIENT
– *APPROACH
– *TIME
•
• 2. Verify all new or questionable orders
with physician or nurse.
• 3. Use meds in clearly labeled containers,
check it 3X (pharmacy/cabinet, before,
after prep)
• 4. Check expiry date, changes:clarity,odor
• 5. Aseptic tx:wash hand,caps upside down
• 6. Meds id with correct client
• 7. Check for allergies: ANST
• 8. Inform client: meds, tx, purpose
• 9. Stay with clients until meds taken
• 10. Report to Dr: client vomits
• 11. Record admin of drug asap: chart any
omission, initial, give rationale
• 12. For meds errors: report asap
• 13. For safety, give only meds YOU prep.
• COMMON DOSAGE FORMS:
• CAPLET= solid for oral use, shaped like a
capsule and coated for ease of swallowing
• CAPSULE=solid, meds in powder, liq, oil
encased by gelatin shell
• ELIXIR=clear fluid c water/ROH;PO;
usually c sweetener
• ENTERIC TAB= tablet coated with
materials that dissolves in intestine
• EXTRACT= concentrated form made by
removing active portion of meds from its
other components
• GLYCERITE= soln of meds combined c
glycerine(50%) for external use.
• INTRAOCULAR DISK= small, flexible oval
if moistened by ocular fluid, releases meds
up to 1 week.
• LINIMENT=prep c ROH, oil, soapy
emolient applied to skin
• LOTION= MEDS IN LIQUID
SUSPENSION APPLIED EXT TO
PROTECT SKIN
• OINTMENT= semisolid, externally applied
prep, c 1 or more meds
• PILL= solid form,1 or > meds, shaped into
globules, ovoids, oblong
• SOLUTION= liquid, used PO, IV,
externally, instilled c body
• SUPPOSITORY= pellet-shaped solid c
gellatin for insertion into body cavity
• SUSPENSION= fine frugparticles
dispersed in liq medium w/c settles on
standing, shake
• SYRUP=meds dissolved in concentrated
sugar solution
• TABLET= powder pressed into disk or
cylinders, contains binders (adhesive),
disintegrators (for tab dissolution),
lubricants, fillers (for convenient tab size)
• TINCTURE= ROH or H20 meds soln.
• TRANSDERMAL PATCH= meds in semi-
permeable membrane disk or patch
absorbed thru skin
• TROCHE/ LOZENGE= flat & round form,
dissolves in mouth to release meds,
contains mucilage, sugar and flavoring
• ROUTES OF ADMINISTRATION
• VIA MOUTH
• 1.ORAL
• =take c 50-100 ml of cold fluid unless CI
• CI: GI dysfxn (vomiting), unconscious or
unable to swallow, NPO per/post-op
• DisAdv: GI irritation, inactivation by gastric
acid, unpleasant taste/odor, teeth
discoloration.
• Remember: Sit client upright to enhance
swallowing
• When preparing solid meds:
• Only scored tablets may be broken
• Crush tab only when appropriate
(children,elderly,dysphagia)
• For enteric-coated tabs:don’t crush, give c
antacid,milk

• When preparing liquid meds:

• Shake suspensions and pour away from
label to prevent dirtying it
• Read amount at meniscus and at eye level
• Wipe lip and neck of bottle before re-capping
• Evaluate client’s response to meds after 30 min.
If client vomits after taking meds, inform
physician. Do not give again.
• 2. SUBLINGUAL
• Place meds under tongue until it dissolves. Do
not swallow or take with fluid. (gastric acid
deactivate meds)
• Fast absorption thru blood vessels under the
tongue
• BUCCAL
• Place meds against mucous membranes
of the cheek.
• Also not swallow or taken with fluid
• TOPICAL MEDICATIONS (SKIN, NOSE,
EYE, EAR, VAGINA, RECTUM)
• 1. VIA SKIN
• Use gloves, gauze or sterile applicator
• Cleanse skin with soap & warm water to
remove encrustation that blocks contact &
absorption of new meds.
• Remember:
• Lotion & creams: applied gently, not
rubbed
• Liniment: rubbed into skin gently but firmly
• Powder: dusted lightly to cover affected area
thinly
• Transderm patches: remove backing and place
patch in area with little hair, use gloves to avoid
drug absorption
• NTG patch: take BP before & after application
• 2. VIA NOSE
• Have client blow nose, lie supine and breathe
thru mouth
• Position head as follows for 5 min to ensure
absorption
• Posterior pharynx: head tilted backward
• Ethmoid & sphenoid sinus: head
hyperextended, tilted over HOB
(Parkinson’s position)
• Frontal & Maxillary sinus: Hyperextended
& side wards (Proetz)

• Place dropper 1 cm above nares &

squeeze quickly, not to touch nose with
applicator
• Client may wipe but not blow nose
• Meds may produce unpleasant taste or coughing
• CI: to decongestants (most common nasal
meds): HPN, heart disease
• 3. VIA EYE
• Gently clean eyelid of crusts or discharge using
gauze in saline. Wipe from inner-outer canthus.
• For Eyedrops: Client looks up, use
thumb/forefinger to pull down cheekbone & pull
up lid exposing lower conjunctiva.
• Drop prescribed meds & ask client to blink/close
eys
• For Eye Ointment
• Squeeze thin stream along inner edge of lower
conjunctiva from inner to outer canthus. Don’t
touch eye with container, twist tube to break
stream.
• Client closes eyes, then lightly rub lid in circular
motion.
• 4. VIA EAR
• With client side-lying, straighten ear canal by
pulling ear
• Assess for eardrum perforation or DC.
• Warm meds in hands (avoids vertigo). Hold
dropper 1 cm above ear & instill meds, Maintain
for 2-3 min.
• For irrigation: place towel under client’s
head. Irrigate with 50 ml of fluid.
• 5. VIA VAGINA
• Privacy, void 1st
• Position: dorsal recumbent, over bedpan if
for irrigation
• Use gloves, then retract labia with non-
dominant hand
• For suppositories: With dominant hand,
apply water-based lubricant on rounded
end of suppository and insert 3-4 inches
down.
• Store suppositories in ref to avoid melting
• For creams, jelly, irrigating solutions (douche)
• Insert applicator 2-3 inches down & deposit
meds.
• Client remains in position for 15-20 min.
• 6. VIA RECTUM
• Sim’s, breathe slowly thru mouth
• Apply lubricant, insert tapered end past internal
anal sphincter (kids: 2”) & hold buttocks togeter
as client may expel suppository.
• INHALANT MEDS: METERED DOSE
INHALERS
• These clients depend on meds for
adequate control of airway obstruction &
must learn self-admin.
• Position:upright (sitting or standing)
• Shake inhaler then have client inhale &
exhale deeply
• 3-point/lateral hand position: client holds
inhaler, thumb at bottom of mouthpiece &
index & middle finger at the top.
• Place inhaler in mouth or 1-2 “ away if c
spacer
• Client inhales deeply, presses canister
• Hold breath for 10 sec then exhale thru
pursed lips.

• PARENTERAL MEDS (NEEDLE/INJXN)

• AMPULE PREP:
• Tap neck to move fluid down ampule then
snap off neck towards self. Hold ampule
upside down, quickly draw meds s needle
touching rim
• Keep tip of needle under fluid to avoid
aspirating bubbles. If aspirated do not
expel air in ampule
• To expel bubbles, tap syringe to move
bubbles up & draw back plunger slightly
then push to expel air.
• VIAL PREP (SOLUTION)
• Multi-dose vials: Wipe off rubber stopper
with ROH pledget
• S contaminating plunger, draw up air in
equal to amt of meds needed & inject air
into vial. This prevents (-) pressure buildup
• Insert needle thru center of rubber seal.
Keep tip below fluid level & allow pressure
in vial to fill syringe
• Before injecting, change dulled needle
• VIAL PREP (POWDER FOR RECON)
• Prepare diluent & inject into vial. Remove
needle & roll vial in palms. Don’t shake
• Use filter needle when drawing up recon
meds.
• Mixing Meds
• 2 vials=Inject air into vial A & withdraw
needle (tip must not touch soln)
• Inject air into vial B & withdraw meds.
Change needle.
• Inject new needle into vial A and withdraw
meds.
• VIAL TO AMPULE: Draw meds from vial-
ampule
• ADMINISTERING INJECTIONS
• Select appropriate site avoiding bruised / tender
areas & rotating sites AMAP.
• Clean site with ROH swab. Use gloves to
prevent contact with client blood.
• Insert needle quickly, bevel up, then release
hold to < pain.
• Aspirate for blood. Re-insert if with blood unless
it IV
• Inject slowly. Press swab over site before
removing needle.
• Massage area except Z track or heparin injxn
• Airlock IM Tx: for
interferon, DPT
vaccine
• Most common site of
heparin injxn:
abdomen
 Site Syringe Needle Method Remarks

ID Ventral 0.1-1 ml G: 26 Stretch Don’t

upper skin,
arm, L:3/8 insert massa
scapula,
5/8 needle ge
chest 10-15 2-
3mm
deep
LUA, K: 0.5-1ml Pinch skin to Don’t
SQ G:25-27 form fold,
anterior aspirate or
A: 1-3ml L:3/8 5/8 dart palm
thigh, massage
down.
abdomen 1/2 45/90
for heparin
or insulin
injxn
Gluteus, G:21-23 Hold like Z track
IM K:.5-1ml dart. Insert.
A&M thigh, L:1” (K) IM: <
deltoid A:2-3 ml 1 1/2 “ (A)
Inject 10-20
irritation
sec
• INTRAVENOUS ADMINISTRATION
• Microtubing: 60 gtts/ml, rates >12 h
• Macrotubing: all other rates
• VENIPUNCTURE
• 1. Prepare infusion set. Place roller clamp 1-2
inches below drip chamber & move to off
position. Insert spike into fluid bag.
• 2. Prime fill drip chamber & tubing (up to
adapter) c solution.
• 3. Remove any air bubbles by tapping tubings
• 4. Apply tourniquet & select a vein
• 5. Use the most distal site in non-dominant
arm
• 6. Dilate vein:close-open fist
• 7. Cleanse site then anchor vein using
thumb & stretch skin opposite the direction
of insertion
• Types IV Admin:
• 1. IV push via hep lock
• a. 2 ml saline: flush
• b. admin meds
• c. 2 ml saline: flush
• d. 10-100 U heparin: flush

• 2. IV push via existing line

• Occlude primary IV line by pinching tubing
just above injxn port closest to pt, give
meds & release tubing
• 3.IV infusion
• Inject meds thru port thru port in IV bag
with rubber stopper not thru air vent or
port for IV tubing.
• 4. Piggyback/Add med solution bag to an
existing line
• *connect IV tubing to meds bag. Hang
med bag higher than primary bag if
piggyback
• DOSAGE CALCULATION
• A. DRUG DOSAGE=D x Q
• S
eg: erythromycin 250 mg PO, stock: 125mg/5ml
250mg/125 mg X 5 ml= 10 ml
For drugs that need dilution:
IM=2 cc
IV < 500= 5 cc
IV >500= 10 cc
Eg 5 FU 259 mg IV; stock: 500 mg vial
250 mg/500 mg X 5 cc dil=2.5 cc
• PEDIA DRUG DOSAGE
• 1. BSA (M2)=sq rt WEIGHT (kg) x HT (cm)

• 3600
• Child’s dose = child’s BSA X AD
• Adult’s BSA (1.73 m2)
• 3 yo weighs 15 kg, ht of 92 cm is to be
given Demerol; AD for Demerol is 100
mg/dose
•
• Based on body weight
• = mg/kg/dose X wt (kg) X Q
• S
• eg: Paracetamol 15 mkd for child weighing
20 kg. Stock: 250 mg/5 ml

Based on Age
Fried’s: birth-12 months
Infant’s dose= age in months X AD
150
• Young’s= (1-12 years)
• Child’s Dose= age in years X AD
• age in yrs + 12
• Clark’s Rule=
• Child’s Dose= wt of child in lbs X AD
• 150 lb