Mrs.Mahdia Samaha Kony 9/18/2015 1 Mrs, Mahdia Samaha Kony

Mrs.Mahdia Samaha Kony

04/19/23 1Mrs, Mahdia Samaha Kony

• Pharmacokinetic; is the study of the movement of drug molecules in the body in relation to drug’s absorption, distribution, metabolism and excretion.

• Absorption; is the process by which a drug is transferred from its site of entry into the body to the bloodstream.


1. Route of administration; the injection medications are usually absorbed more rapidly than oral medications

2. Drug solubility; liquid medication are absorbed more rapidly than solid preparations

3. PH; the form in which the drug is found depend on the pt of the environment; acidic drugs are well absorbed in the stomach.


4. Local conditions at the site of administration; a pt with burn would have poor absorption from intramuscular injection, also food in the stomach can delay the absorption of some medications.

5. Drug dosage; a loading dose or a large than normal dose is usually given when the pt is in acute distress and it is necessary to achieve the maximum therapeutics effects as quick as possible.


6. Serum drug level:

a) Therapeutic range: is the concentration of drug in the blood serum that produces the desired effect without causing toxicity.

b) Trough level; is the point when the drug is at its lowest concentration and this specimen is usually drawn in the 30 minutes interval before the next dose.

c) Peak level; or highest plasma concentration of the drug should be measured when absorption is complete

d) Drug half – life; (elimination half – life): The time required for the elimination process to reduce the concentration of the drug to one – half what it was at initial administration.


Is the transportation of a drug from its site of absorption to its site of action. When a drug enters the blood stream, it is carried to the most vascular organs- that is, liver, kidneys, and brain.


Metabolism or Biotransformation; also called detoxification or metabolism, is a process by which a drug is converted to a less active form.

Biotransformation may be altered if a person is very young, is older, or has an unhealthy liver.


Is the process by which metabolites and drugs are eliminated from the body. Most metabolites are eliminated by the kidneys in the urine; however, some are excreted in the feces, the breath, perspiration, saliva, and breast milk.


Allergic effects; occurs in persons previously exposed to the drug and IGE was formed.

Symptoms range from minor to serious and reaction can occur immediately or delayed after hours to days.

Signs and symptoms:1. Rash2. Urticaria3. Fever4. Diarrhea5. Nausea and vomitting


Serious immediate reaction; anaphylactic reaction result I respiratory distress, sudden severe bronchospasm and cardiovascular collapse.

Treatment; epinephrine; antihistamine, bronchodilators.


Cumulative effect; result when the dose of drug is given before the body excrete the previous dose, if the drug reach the level of toxicity it can damage the body organs such as the liver and kidney.

Idiosyncratic effect; abnormal response to drug that may be manifested as over response, under response or response different from the expected outcome.


Drug interaction; there is a combined effect of two or more drugs acting simultaneously that result in:

Antagonist effect; the effect of drug is less than that of each drug alone

Synergistic effect; the effect of drug is greater than that of each drug alone.

Drug interactions become serious risk with elderly population


Developmental factors;

During pregnancy; drugs taken during pregnancy pose a risk throughout the pregnancy, but pose the highest risk during the first trimester, due to the formation of vital organs and functions of the fetus during this time.

Most drugs are contraindicated because of their possible adverse effects on the fetus and certain drugs referred to as teratogenic drugs are known to have potential to cause developmental defects in the embryo or fetus.


Infant usually require small dosages because of their body size and the immaturity of their organs, especially the liver and kidneys.


Weight; nurses should know the weight especially before the operation in order to calculate the correct dose for drugs.

Gender; differences in the way men and women respond to drugs are chiefly related to the distribution of body fat and fluid and hormonal differences.

Cultural and Genetic factors; Pharmacology; is the study of the effect of drugs on living organisms. It study the differences in drug responses in various ethnic or racial groups.


Psychological factors; a client’s expectations about what a drug can do can affect the response to the medication. For example, a client who believes that codeine is ineffective as an analgesic may experience no relief from pain after it is given. A placebo; is pharmacologically inactive medication

Pathology; the presence of a disease affect the action of drugs. The liver is the primary organ for drug breakdown and the pathologic conditions that involve the liver may slow down metabolism


Environment; for example receiving medication in an environment that lack of oxygen effects drug reaction, also pt who receives pain medication or sedative in a busy, noisy environment may not benefit as fully as if the environment were quiet and peaceful.


Time of administration; the presence of food in the stomach delays the absorption of oral administration of medication, some medications should be given with the food to prevent gastric irritation.

Diet; nutrients can affect the action of a medication, for example, vitamin K found in green leafy vegetables can counteract the effect of an anticoagulant such as warfarin.


Medication ordered:

No medication given to a client without order from physician or nurse practitioners


A standing order may be carried out as specified until an order is written to cancel it, or it may be carried out for a specified number of days (e.g., Demerol 100 mg IM q4h × 5 days).

As Needed or prn ; the pts receives medication when it is requested or needed, usually written for postoperative orders pain management


Single order or one – time order is for medication to be given once at a specified time by the physician such as a medication to be administrative immediately before surgery

Stat order indicates that the medication is to be given immediately and only once.


– Client’s full name; full name is used

– Date & time the order is written in order to prevent errors

– Name of the drug to be administered– Frequency of administration such as Q 4 hours, Bid.– Dosage of the drug– Route by which the drug to be administered– Signature of the person writing the order; the name

signature and title, it is important for a legal reason.


– Checking the medication order; that is written on a Kardex 3 times

– Questioning the medication order, because the nurse is legally responsible for the drug administer any order suspected to be an error should be questioned, guessing is a gross carelessness rechecking with the person who wrote the order is the only safe procedure.


Stock supply system; large quantities of medications are kept on the nursing unit.

Individual supply system; each patient is supplied with medications needed for a period of time.

Unit dose system; the pharmacist simplifies medication preparation by packing and labeling each dosage for a 24- hour period.

A computerised medication system; has drawers stocked with approved medications, and provides access to the medications ordered for each patient.


04/19/23Mrs, Mahdia Samaha Kony 25


Metric system: each unit can be divided into multiple of ten

a) Weight

1000µg =1mg

1000mg =1g

1000g =1kg

b) Volume

1000ml=1L


Tea spoon Table spoon Tea cup Glass


Several formulas can be used to calculate drug dosages.

One formula uses ratio:

Dose on hand = dose desired

Quantity on hand quantity desired

For example, erythromycin 500mg is ordered. It is supplied in a liquid form containing 250mg in 5 ml. Calculate the dosage by using this formula.


Calculation according to the child’s weight or body surface “BSA” and the formula calculating child dose are:

BSA “child” (m2) X normal adult dose = child’s dose

BSA adult ( average 1.7m2)

For example, a child who weighs 10 kg and is 50cm tall has a body surface area of 0.4m2, Therefore, the child’s dose of tetracycline corresponding to an adult dose of 150mg would be?


Three checks and five rights

Three checks; the medication container should be checked

1. When the nurse reaches for the container or unit dose package.

2. Immediately before pouring or opening the medication

3. when replacing the container to the drawer or shelf or before giving the unit dose medication to the pt.


The nurse gives the;

1. Right medication to the

2. Right patient in the

3. Right dosage through the

4. Right route at the

5. Right time


Right client education. Explain information about the medication to the client

Right documentation. Promptly and accurately document the medication administration

Right to refuse. Adult clients have the right to refuse any medication.

Right assessment. Some medication requires specific assessments prior to administration (e.g., apical pulse, blood pressure, lab result).

Right Evaluation. Was the desired effect achieved or not?


Such as good lighting when preparing the medication better for the nurse while preparing the drugs to be alone, no distraction, locked the drawer after preparing, each pt, giving drug recording is important.


• Caring through locked drawer or container• Caring for Narcotic• Checks the identification cart or bracelet before giving

the medication Healthcare agencies provide forms for keeping such

records, and these forms are kept with the narcotics. Although the forms differ, the following information usually is required:

1. Name of the patient receiving the narcotic

2. Amount of the narcotic used

3. Hour the narcotic was given

4. Name of the physician who prescribed the narcotic

5. Name of the nurse who administered the narcotic04/19/23 35Mrs, Mahdia Samaha Kony


1- Oral MedicationIs the most common, least expensive, convenient, safe.In oral medication the drug is swallowed.


Forms of oral medication are:

- Solid; include tablets, capsules, and pills - Liquid; such as syrup, suspension and can be taken

either by measured cup or syringes.


– Unpleasant taste of the drugs– Irritation of the gastric mucosa– Irregular absorption from the gastrointestinal

tract, slow absorption– In some cases harm to the client’s teeth. (e.g.,

liquid preparation of ferrous sulfate)– Sometimes pt hides medication in the mouth or

cheek, so the nurse should make sure that the pt swallowed med. before recording


The following techniques help disguise or mask an objectionable taste:

Crush the medication and add it to food or a drink so that the patient can swallow it.

Allow the patient to suck on a small piece of ice for a few minutes before taking the medication.

Store oily medications in the refrigerator.


Place the medication in a syringe, and place the syringe well back on the tongue, being careful not to trigger the patient’s gag reflex.

Offer oral hygiene immediately after giving the medication.

Give the medication with generous amounts of water or other liquids, if permitted, to dilute the taste.


Children. It can be challenging and frustrating to administer medications to infants and children.

Children younger than 5 years have difficulty swallowing tablets and capsules.

Most medications are available in liquid form. Nursing responsibility also includes teaching and preparing

family members to administer medications to a child at home.

Understanding the medication order and the reason for the medication, the caregiver should be able to demonstrate any special techniques involved in administering the prescribed drugs.


Use a dropper to give infants or very young children liquid medications while holding them in a sitting or semi sitting position. Place the medication between the gum and cheek to prevent aspiration.

Crush uncoated tablets or empty a soft capsule and mix the medication with soft foods, such as potatoes for patients who are likely to aspirate liquids.

If a medication has an objectionable taste, warn the child, if he or she is old enough to understand.


Take care when selecting the food to be mixed with the medication. The item should not be an essential part of

the child’s diet, such as formula or the child’s favorite food. The child may refuse to eat a food associated with medications.

Offer the child a flavored ice pop or frozen fruit bar immediately before taking the medication.

Praise the child for a job well done after he or she swallows the medication.


Use liquid medications or medications that can be crushed and combined with liquid.

Bring the liquid medication to room temperature.

Remove the clamp from the tube and check tube placement in the stomach or intestine.

Flush the tube with 15 to 30 mL water (5 to 10 mL for children) before giving the medication and immediately after giving the medication.


Give medications separately and flush with water between each drug.

If the tube is connected to suction, keep it disconnected

from the suction and clamped for 20 to 30 minutes after administration of the medication to allow absorption.

Disconnect a continuous tube feeding before giving medications, and leave the tube clamped for a short period of time after the medication has been given.

Document the water intake and liquid medication by tube on the intake and output record.



See table 35-6 Page 839


Certain situation that oral med shouldn’t be administered:

1.Pt has difficulty in swallowing

2.Unconscious

3.NPO


2- Sublingual Medication

- A drug is placed under the tongue where it dissolves

-The drug is largely absorbed into the blood vessels on the underside of the tongue.

The medication should not be swallowed.

- May cause stinging or irritation of the mucous membranes.


3- Buccal Medication “pertaining to the cheek’’

A medication (e.g., a tablet) is held in the mouth against the mucous membranes of the cheek until the drug dissolves.


Enteral means within the intestines Parenteral means outside the intestines or alimentary

canal Absorption occurs more rapidly with an injection than

when other routes are used Intravenous injections are absorbed more rapidly than

intramuscular ones The effects of intramuscular injections usually last

longer due to the increased absorption time.


Needles are available in various lengths and gauges, with different sizes of bevels.

The needle length used depends on the route of administration

The gauge is determined by the diameter of the needle. Needle gauges are numbered 18 through 30.

As the diameter of the needle increases, the gauge number decreases.

The bevel of the needle is its sloped edge, designed to make a narrow, slit like opening that closes quickly.


Syringes are supplied in various sizes. Most syringes are plastic and disposable.

Some syringes are supplied with the needle attached; others are not, in which case you should select an appropriate needle.

Choose the equipment needed for an injection based on the following criteria:

Route of administration: A longer needle is required for an intramuscular injection than for an intradermal or a subcutaneous injection.

Viscosity of the solution: Some medications are more viscous than others and require a large-lumen needle to inject the drug.


Quantity to be administered: The larger the amount of medication to be injected, the greater the capacity of the syringe.

Body size: An obese person requires a longer needle to reach muscle tissue than a thin person.

Type of medication: There are special syringes for certain uses. An example is the insulin syringe used to inject insulin.



Defined as other than through the alimentary or respiratory tract; that is by needle. The following are some of the more common routes for parenteral administration:

- Subcutaneous (Hypodermic) – into the subcutaneous tissue, just below the skin.


- Intramuscular – into the muscle

- Intradermal – under the epidermis (into the dermis)

- Intravenous – into a vein

The less commonly used routes are:1. Intra – arterial (into an artery).

2. Intracardiac (into the heart muscle)

3. Intraosseous (into a bone)

4. Intrathecal or intraspinal (into the spinal canal)

5. Intrapleural (into the pleural space)

6. Epidural (into the epidural space)

7. Intraarticular (into a joint).




Intra articular (into a joint).


Are those applied to a circumscribed surface area of the body. They affect only the area to which they are applied. They include the following:

Dermatologic preparations : Applied to the skin

Instillations and irrigations :Applied into body cavities or orifices, such as the urinary bladder, eyes, ears, nose, rectum, or vagina

Inhalations: administered into the respiratory tract by nebulizer.


Landmarks for the deltoid injection

Landmarks for the vastus lateralis injection site


Land marks for dorsogluteal site

Ventrogluteal site


Landmarks for the rectus femoris injection site


1. Your patient with diabetes receives glipizide 10mg PO every morning. The drug is supplied in 5mg scored tablets will you administer?

2. Mr. Theson receives Vistaril 60mg PO q6 h for relief of nausea after his acoustic neuroma revision. Vistaril oral suspension, 25 mg/5ml, is supplied. How many milliliters will the nurse administer?


3. Your patient receives Keflex 0.5 g PO four times a day. You have Keflex 250 mg capsules available. How many capsules will you administer?

4. The doctor orders Lanoxin elixir 20 mcg PO now. You have Lanoxin 0.1 mg/mL .What is the amount to be given?


5. The physician prescribes KCL 20 mEq po twice a day for Hypokalemia. KCL liquid is supplied 30mEq/ 22.5 mL. How many milliliters will the nurse administer per dose?

6. Ordered: Keflin 400.000 U. Available; avail with 600.000 U/mL. How many milliliters will you administer?


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Mrs.Mahdia Samaha Kony 9/18/2015 1 Mrs, Mahdia Samaha Kony