NUR 100 Pharmacology Packet for students #2GRADED A
Revised Winter 2016
,NUR 100 Pharmacology Packet for students #2GRADED A
NUR100 Pharmacology
Safe Medication Administration
I. Assessment
A. Subjective information – patient drug history, complaints, response to treatment
B. Objective information – physical exam, vital signs, laboratory tests
II. Complete medication History
A. Over the counter (OTC) medications
B. Prescription (Rx) medications
C. Street drugs
D. Herbal supplements
E. Allergies
i. AKA
ii. NKA
iii. NKDA
F. Diseases
G. Growth and development
III. Groups prone to adverse drug reactions
A. Immunocompromised
B. Renal (kidney disease) – know BUN (blood urea nitrogen) and creatinine
C. Hepatic (liver disease, alcoholism) – know LFTs (liver function tests) – ALT, AST, alk phos
D. Genetic factors
E. Drug allergies
F. Pregnancy
G. Infants and children (immature organs)
H. Elderly (deteriorating organs)
IV. Drug Information
A. Drug handbook/guide (i.e., Mosby’s Drug Reference)
B. Pharmacology textbook (Lilley)
C. Physician’s Desk Reference (PDR)
D. Drug Manufacturer Insert
E. Micromedex (iPhone app) and other online drug formularies
F. Only if the above resources are not available, a registered pharmacist may be contacted.
V. The 6 rights of medication administration (and then some
A. Right drug – verify spelling with drug order (MAR)
B. Right dose – verify calculations (ask another RN to double check, if in doubt)
C. Right time – one hour before to one hour after time scheduled (note exceptions)
D. Right route – do not assume route (verify with prescriber if doubt)
E. Right patient – check ID band; have patient state name and date of birth (compare to MAR)
F. Right documentation – document on MAR; document PRNs and patient response in chart
G. Right education – use every opportunity to teach patient and/or family regarding their
meds, nonpharmacologic measures to enhance drug therapy (diet, exercise, lifestyle
changes, etc.)
H. Right response – an 8th right of medication administration to consider
I. Right to refuse – a 9th right of medication administration is the patient’s right to refuse treatment
Prepared by C. Sproles 1.15.2012/Rev. 12.17.2015 2
,NUR 100 Pharmacology Packet for students #2GRADED A
VI. Drugs with similar names
A. SALAD – sound-alike look-alike drugs
B. LASA – look-alike sound-alike
Be careful not to rely on information from your peers or co-workers because YOU are the one responsible for
administering the right drug!!
Lifespan Considerations
I. Drug therapy during pregnancy
A. During the trimester of pregnancy the fetus is at the greatest risk for drug-induced
developmental defects. The embryonic period (weeks 3-8) is when expectant mothers must take
special care to avoid exposure to teratogens.
B. During the trimester the greatest percentage of maternally absorbed drug will get to the
unborn baby. Know why! Increased blood flow and lipid soluble drugs cross the placenta the easiest.
C. Assume that any drug taken can cross the placenta
D. Must use drugs judiciously, during pregnancy induced hypertension, epilepsy, diabetes, asthma, and
infection could seriously endanger both the mother and baby.
II. FDA Pregnancy Category Classifications
CATEGORY CATEGORY DESCRIPTION
A Studies indicate no risk to the human fetus.
B Studies indicate no risk to the animal fetus; information for humans not available.
C Animal studies w/ adverse effects reported in fetus; no controlled studies in women.
D Possible fetal risk in humans has been reported; potential benefit versus risk may
warrant treatment in pregnant women (asthma, hypertension, epilepsy, infection).
X Absolutely contraindicated. Proven risk of fetal abnormality. No possible benefits.
III. Breastfeeding
A. A wide variety of drugs easily cross from mother’s circulation to breast milk.
B. Dose immediately breast feeding to minimize drug concentrations.
C. Avoid drugs with half-lives; choose drug with the smallest effect; avoid hazardous
drugs.
IV. Neonatal and pediatric considerations
A. Dose calculations: height and weight based (kg) on BSA (body surface area); more accurate method
B. Calculating the dosage according to body weight is the most commonly used method. Most drug
references recommend dosages based on milligrmas per kilogram of body weight. For example: 5
mg/kg
Approximate child’s dose =
Body surface area of the child X Adult dose
1.7 m2
BSA of adult
X adult dose = estimated child’s dose
BSA of child
C. Organ system immaturity
D. More sensitive to drug effects\
E. Infants are especially sensitive to drugs that affect CNS (blood-brain barrier not fully developed)
Prepared by C. Sproles 1.15.2012/Rev. 12.17.2015 3
, NUR 100 Pharmacology Packet for students #2GRADED A
V. Geriatric considerations
A. Polypharmacy and drug use
B. Geriatric patients take an estimated 40% of OTC medications
C. 1/3 of geriatric people take more than 8 drugs
D. As the number of meds increases, so does the risk of a drug interaction. With 10 drugs there is
a 100% risk of drug interactions
E. Drug nonadherence/noncompliance is reported to occur in approximately 40% of elderly
population
F. Drug accumulation (renal and hepatic functions decreased)
G. Know problematic geriatric medications (see Beer’s criteria)
Physiological Changes in the Elderly
I. Absorption of Drugs
A. Decreased gastric acidity (increased gastric pH)
B. Decreased absorptive surface area
C. Decreased splenic blood flow
D. Decreased GI motility
E. Delayed gastric emptying
II. Distribution of Drugs
A. Increased body fat
B. Decreased lean body mass
C. Decreased total body water
D. Decreased serum albumin (protein)
E. Decreased cardiac output
III. Metabolism of Drugs
A. Decreased hepatic blood flow
B. Decreased activity of hepatic enzymes
C. Decreased hepatic mass
IV. Excretion of Drugs
A. Decreased renal blood flow
B. Decreased glomerular filtration rate
C. Decreased tubular secretion
D. Decreased number of nephrons
Prepared by C. Sproles 1.15.2012/Rev. 12.17.2015 4
Revised Winter 2016
,NUR 100 Pharmacology Packet for students #2GRADED A
NUR100 Pharmacology
Safe Medication Administration
I. Assessment
A. Subjective information – patient drug history, complaints, response to treatment
B. Objective information – physical exam, vital signs, laboratory tests
II. Complete medication History
A. Over the counter (OTC) medications
B. Prescription (Rx) medications
C. Street drugs
D. Herbal supplements
E. Allergies
i. AKA
ii. NKA
iii. NKDA
F. Diseases
G. Growth and development
III. Groups prone to adverse drug reactions
A. Immunocompromised
B. Renal (kidney disease) – know BUN (blood urea nitrogen) and creatinine
C. Hepatic (liver disease, alcoholism) – know LFTs (liver function tests) – ALT, AST, alk phos
D. Genetic factors
E. Drug allergies
F. Pregnancy
G. Infants and children (immature organs)
H. Elderly (deteriorating organs)
IV. Drug Information
A. Drug handbook/guide (i.e., Mosby’s Drug Reference)
B. Pharmacology textbook (Lilley)
C. Physician’s Desk Reference (PDR)
D. Drug Manufacturer Insert
E. Micromedex (iPhone app) and other online drug formularies
F. Only if the above resources are not available, a registered pharmacist may be contacted.
V. The 6 rights of medication administration (and then some
A. Right drug – verify spelling with drug order (MAR)
B. Right dose – verify calculations (ask another RN to double check, if in doubt)
C. Right time – one hour before to one hour after time scheduled (note exceptions)
D. Right route – do not assume route (verify with prescriber if doubt)
E. Right patient – check ID band; have patient state name and date of birth (compare to MAR)
F. Right documentation – document on MAR; document PRNs and patient response in chart
G. Right education – use every opportunity to teach patient and/or family regarding their
meds, nonpharmacologic measures to enhance drug therapy (diet, exercise, lifestyle
changes, etc.)
H. Right response – an 8th right of medication administration to consider
I. Right to refuse – a 9th right of medication administration is the patient’s right to refuse treatment
Prepared by C. Sproles 1.15.2012/Rev. 12.17.2015 2
,NUR 100 Pharmacology Packet for students #2GRADED A
VI. Drugs with similar names
A. SALAD – sound-alike look-alike drugs
B. LASA – look-alike sound-alike
Be careful not to rely on information from your peers or co-workers because YOU are the one responsible for
administering the right drug!!
Lifespan Considerations
I. Drug therapy during pregnancy
A. During the trimester of pregnancy the fetus is at the greatest risk for drug-induced
developmental defects. The embryonic period (weeks 3-8) is when expectant mothers must take
special care to avoid exposure to teratogens.
B. During the trimester the greatest percentage of maternally absorbed drug will get to the
unborn baby. Know why! Increased blood flow and lipid soluble drugs cross the placenta the easiest.
C. Assume that any drug taken can cross the placenta
D. Must use drugs judiciously, during pregnancy induced hypertension, epilepsy, diabetes, asthma, and
infection could seriously endanger both the mother and baby.
II. FDA Pregnancy Category Classifications
CATEGORY CATEGORY DESCRIPTION
A Studies indicate no risk to the human fetus.
B Studies indicate no risk to the animal fetus; information for humans not available.
C Animal studies w/ adverse effects reported in fetus; no controlled studies in women.
D Possible fetal risk in humans has been reported; potential benefit versus risk may
warrant treatment in pregnant women (asthma, hypertension, epilepsy, infection).
X Absolutely contraindicated. Proven risk of fetal abnormality. No possible benefits.
III. Breastfeeding
A. A wide variety of drugs easily cross from mother’s circulation to breast milk.
B. Dose immediately breast feeding to minimize drug concentrations.
C. Avoid drugs with half-lives; choose drug with the smallest effect; avoid hazardous
drugs.
IV. Neonatal and pediatric considerations
A. Dose calculations: height and weight based (kg) on BSA (body surface area); more accurate method
B. Calculating the dosage according to body weight is the most commonly used method. Most drug
references recommend dosages based on milligrmas per kilogram of body weight. For example: 5
mg/kg
Approximate child’s dose =
Body surface area of the child X Adult dose
1.7 m2
BSA of adult
X adult dose = estimated child’s dose
BSA of child
C. Organ system immaturity
D. More sensitive to drug effects\
E. Infants are especially sensitive to drugs that affect CNS (blood-brain barrier not fully developed)
Prepared by C. Sproles 1.15.2012/Rev. 12.17.2015 3
, NUR 100 Pharmacology Packet for students #2GRADED A
V. Geriatric considerations
A. Polypharmacy and drug use
B. Geriatric patients take an estimated 40% of OTC medications
C. 1/3 of geriatric people take more than 8 drugs
D. As the number of meds increases, so does the risk of a drug interaction. With 10 drugs there is
a 100% risk of drug interactions
E. Drug nonadherence/noncompliance is reported to occur in approximately 40% of elderly
population
F. Drug accumulation (renal and hepatic functions decreased)
G. Know problematic geriatric medications (see Beer’s criteria)
Physiological Changes in the Elderly
I. Absorption of Drugs
A. Decreased gastric acidity (increased gastric pH)
B. Decreased absorptive surface area
C. Decreased splenic blood flow
D. Decreased GI motility
E. Delayed gastric emptying
II. Distribution of Drugs
A. Increased body fat
B. Decreased lean body mass
C. Decreased total body water
D. Decreased serum albumin (protein)
E. Decreased cardiac output
III. Metabolism of Drugs
A. Decreased hepatic blood flow
B. Decreased activity of hepatic enzymes
C. Decreased hepatic mass
IV. Excretion of Drugs
A. Decreased renal blood flow
B. Decreased glomerular filtration rate
C. Decreased tubular secretion
D. Decreased number of nephrons
Prepared by C. Sproles 1.15.2012/Rev. 12.17.2015 4
