PHARMACOLOGY b) they suggested castor oil for a

laxative & opium for pain

 Course Description: This course c) Also suggested that moldy bread
deals with pharmacodynamics, be applied to wounds and bruises
pharmacokinetics, – 3500 years before Alexander
clinical/therapeutic uses and Fleming’s discovery of Penicillin
toxicology of drugs. Emphasis is  Galen
given on how a drug works to a) Roman physician and writer (131-
anticipate when giving a drug to a 201 AD)
patient are of paramount importance b) Was considered an authority in
since nursing responsibilities include medicine & pharmacy for hundreds
administering drugs, assessing drug of years
effects, intervening to make a drug c) Initiated the common use of
more tolerable, and providing prescriptions and used several
teaching about drugs and the drug ingredients to treat a specific illness.
regimen.
Arab Doctors (around 1240 AD)
PHARMACOLOGY a) Formulated the first set of drug
 Is the study of chemicals – drugs – standards & measurements (grains,
on living tissues and how those drams, minims) known as
chemicals help diagnose, treat, cure apothecary system
and prevent disease or the correct b) Currently, the units of the metric
pathophysiology of living tissues. system are used internationally to
 Deals with the study of drugs and measure drugs, the apothecary
their effects on living tissues system is being phased out
Derived from 2 Greek words: 18th century, the following
a) Pharmakon – Greek word for drugs breakthrough drugs were introduced:
b) Logos – Greek word for science a) The vaccine for small pox
b) Digitalis from the foxglove plant for
 Drugs – (Dutch word “droog”) strengthening and slowing the
means dry – are chemical substances heartbeat
that have an effect on living c) Vitamin C from citrus fruits
organisms
19th century
History/Records of Drug Use a) Morphine & Codeine were
Middle East & China – the drugs extracted from opium plant
most commonly used then were b) Atropine, bromides & iodine were
laxatives and emetics to induce introduced
vomiting. c) Amyl nitrate was used to relieved
the pain of angina
Egyptians (1550 BC) d) Anesthetics ether & nitrous oxide
a) wrote their empirical were discovered
observations of drug therapy on Early 20th century
what has come to be known as a) Aspirin was derived from salicylic
Ebers Medical Papyrus; acid

DJC
b) Phenobarbital, insulin & are impure, toxic, ineffective, or not
sulfonamides were introduced tested before public sale
c) History/Records of Drug Use Primary purpose: to ensure safety
1940’s Federal Pure Food & Drug Act of
a) Antibiotics were marketed 1906 – America’s first law to
(penicillin, tetracycline, regulate drugs which did not include
streptomycin) drug effectiveness and safety.
b) Antihistamines & cortisone were
marketed 1938: Food, Drug and Cosmetic Act
1950’s Empowered a governing body, the
a) Antipsychotic drugs, Food & Drug Administration (FDA),
antihypertensives, oral to monitor and regulate the
contraceptives & the polio vaccine manufacture & marketing of Drugs
were introduced FDA’s responsibility: to ensure that
all drugs are tested for harmful
The Drug Approval Process (Drug effects, have labels with accurate
Standards & Legislation) information, and enclose with the
Drug Standards – set of drug drug packaging detailed literature
standards use in the US that explains adverse effects.
1. United Sates Pharmacopeia of Can prevent the marketing of any
1820 drug if judges to be incompletely
2. United States Pharmacopeia tested or dangerous
National Formulary (USP-NF) Only drugs considered safe by FDA
 the current authoritative source are approved for marketing.
for drug standards, is revised every 1938: Food, Drug & Cosmetic Act
five years by a group of experts in  This act required:
nursing, pharmaceutics, 1. Drugs must be proven safe for use
pharmacology, chemistry & before they can be sold
microbiology 2. Inspections for drug manufacturing
 Drugs included in the USP-NF have facilities
met high standards for therapeutic 3. Safe tolerance levels be identified to
use, client safety, quality, purity, prevent the patient from being
strength, packaging safety & dosage poisoned
form 4. Cosmetic and therapeutic devices be
 Drugs that meet these standards have controlled
the initials USP following their 1952: Durham-Humphrey
official name. Amendment to the 1938 Act
3. International Pharmacopeia  Distinguished between drugs that can
 First published in 1951 by WHO, be sold with or without prescription
provides a basis for standards in  Those drugs that should not be
strength & composition of drugs refilled without a new prescription
for use throughout the world. e.g., narcotics, hypnotics,
FEDERAL LEGISLATIONS tranquilizers, must be so labeled
Through federal legislation, the 1962: Kefauver-Harris Amendment to
public is protected from drugs that the 1938 Act

DJC
 Controls on drug safety, especially  Meperidine (Demerol), morphine,
experimental drugs, and required that methadone, oxycodone, codeine,
adverse reaction and amphetamines, secobarbital,
contraindications must be labeled & pentobarbital
included in the literature  Codeine preparations, paregoric,
 Also included in the amendment nonnarcotic drugs (pentazocine,
were: propoxyphene)
 Provisions for the evaluation of  Phenobarbital, benzodiazepines
testing methods used by (diazepam, oxazepam, lorazepam,
manufacturers chlordiazepoxide), chloral hydrate,
 The process for withdrawal of meprobamate
approved drugs when safety and  Opioid-controlled substance for
effectiveness were in doubt diarrhea and cough (e.g., codeine in
 Establishment of the effectiveness of cough preparations)
new drugs before marketing
 This amendment tightened controls Nursing Interventions: Controlled
on drugs safety by requiring drug Substances
manufacturers to use standard  Account for all controlled substances
labeling of drug containers, the label  Keep a special controlled substance
lists adverse reactions & record for required information
contraindications or reasons why the  Countersign all discarded or wasted
drug should not be used. medication
1970: The Controlled Substances  Ensure that records and drugs on
Act/1970 Comprehensive Drug Abuse hands match
Prevent and Control Act  Keep all controlled drugs locked up;
 This act was designed to remedy the narcotics must be kept under double
escalating problem of drug abuse, lock
includes several provisions:  Be certain that only authorized
 The promotion of drug education and persons have access to the keys
research into the prevention and 1978: Drug Regulation Reform Act
treatment of drug dependence.  This reform act shortened the time in
 The strengthening of enforcement which new drugs could be developed
authority and marketed.
 The establishment of treatment and
rehabilitation facilities; & 1992: Drug Relations Act
 The designation of schedules, or  The regulations were changed to
categories for controlled substances increase the approval rate of drugs
according to abuse liability used to treat AIDS and cancer
 The pharmaceutical companies pay a
Schedule Categories for Controlled user fee at the time they file the
Substances application for the new drug. The fee
 heroin, hallucinogenic (LSD, is for FDA drug approval process.
marijuana, (except when prescribed 1997: The Food & Drug
with cancer patients), mescaline, Administration Modernization Act
peyote, psilocybin)  There are 5 provisions in this act,
including the following:

DJC
 Review & use of new drugs is  Are inorganic crystal substances that
accelerated are found naturally on earth. Patients
 Drugs can be tested in children lacking an adequate level of these
before marketing minerals may take specific mineral-
 Clinical trial data are necessary for based drugs to raise the level of
experimental drug use for serious minerals
life-threatening health conditions  Synthetic/Chemical Derivatives
 Drug companies are required to give  Is produced using chemical
information on “off-label drugs and synthesis, which rearranges chemical
their uses & costs derivatives to form a new compound.
 Drug companies that plan to Great strides in molecular biology &
discontinue drugs must inform health biochemistry enable scientists to
professionals & clients at least 6 create man-made drugs
months before stopping drug Herbals
production  Non-woody plants. Some have
2003: Medicare Prescription Drug medicinal qualities classified as a
Improvement & Modernization Act dietary supplement- not a drug
(MMA)  Dietary supplements are not tested or
 Serves to provide financial assistance regulated & can be sold OTC
to seniors to purchase needed without prescription
prescription medications  This lack of monitoring means that
 Currently pharmaceuticals & there are no standards for purity and
insurance company sponsored strength for herbals
discount cards  The law prohibits distributor form
The Source of Drugs claiming that a herbal can cure a
 Plants disease. They can only state the
 A number of plants have medicinal effect of the herbal on the body
qualities & have been used for  Can lead to unwanted S/E and
centuries as natural remedies for undesirable interactions with
injuries and illnesses. Pharmaceutical prescription drugs
firms harvest these plants & Drug names
transform them into drugs that have a Chemical name
specific purity & strength sufficient  Identifies chemical elements &
to treat diseases. compounds that are found in the drug
 Animals  Is important to chemists, pharmacists
 Byproducts of animals, including & researchers who work with the
humans are a source for drug drugs at the chemical level
because they contain hormones that  Ex. N-acetyl-p-aminophenol
can be reclaimed & given to patients (acetaminophen)
who need increased hormonal levels Generic name
to maintain homeostasis  Is the universally accepted name &
considered the official/non-
 Minerals proprietary name for the drug
 Our body requires trace elements in  Not owned by the pharmaceutical
order to maintain homeostasis companies

DJC
  Appears on all drug labels & is the d) Drugs that is unsafe unless
official name listed in official administered under the supervision
sources such as PDR of a licensed practitioner
 Drug names e) New drugs that is still being
 not capitalized investigated & not considered safe
 Cheaper than & the cost is usually for indiscriminate public use
reimbursed by insurance companies f) Antibiotics
Brand/Trade name Non-prescription Drugs
 Also known as proprietary name  Called OTC drugs
 Drug companies often select &  Available to the public without
copyright a trade or brand name for prescription
their drug
 Followed by the symbol ® Food & Drug Administration Pregnancy
 Indicates that the name is registered Category
& its use is restricted to the owner of Pregnancy Description
drug/manufacturer of the product Category
 More costly than generic drugs & are A No risk to fetus. Studies have not
partially reimburse or not covered at shown evidence of fetal harm
B No risk in animal studies & well-
all by insurance companies controlled studies in pregnant women
are not available. It is assumed there is
little to no risk in pregnant women
C Animal studies indicate a risk to the
fetus
D A risk to the human fetus has been
proved. Risk vs. benefit of the drug
must be determined. It could be used in
life-threatening conditions
X A risk to the human fetus has been
proved. Risk outweighs the benefit &
should be avoided during pregnancy

Locating Drug Information

Prescription vs. OTC drugs  Before administering a drug to a
Prescription/legend drugs patient, health care providers need to
 Drugs accessible only by know the following information
prescription from licensed about the drug:
practitioner 1. Generic & trade name – generic
 The drug label must display the name is the official name of the drug
legend “caution Federal law – trade name is the drug’s brand
prohibits dispensing without name
prescription” 2. Clinical uses & indications for use –
 Drugs that fall under this describes the purpose of the drug &
classification are: when the drug is to be given to a
a) Those given by injection patient
b) Hypnotic drugs 3. Mechanisms of action – describes
c) Narcotics how the drug works
4. Adverse & S/E & toxicity –
identifies the effects the drug has
other than the therapeutic effect

DJC
5. s/s to monitor – identifies the Nurse Practice Acts
patient’s physiological response that  In a civil court, the nurse can be
must be evaluated after the drug is prosecuted for:
administered  Giving the wrong drug or dosage
6. What to teach the patient – specifies  Omitting a drug dose
instructions that must be given to the  Giving the drug by the wrong route
patient before & after the drug is  Legal terms for these offenses:
administered  Misfeasance – negligence; giving
the wrong drug or drug dosage that
Locating Drug Information results in the client’s death
1. American Hospital Formulary  Nonfeasance – omission; omitting a
Service (AHFS) Drug Information drug dose that results in client’s
– published by the American Society death
of Hospital Pharmacists, Inc. &  Malfeasance – giving the correct
contains an overview of every drug drug but by the wrong route that
2. US Pharmacopeia Dispensing results in client’s death
Information – published by the US Drug Orders
Pharmacopeial convention &  Also called a medical prescription
highlights clinical information which  Is an instruction from a provider
is the same as the drug inserts found to give a patient medication
in packages of drugs.  Written on a prescription pad or on
3. Physician Desk Reference (PDR) – an order sheet if written in a health
published by medical economics care institution.
with the financial support of the  Are written using the abbreviation &
pharmaceutical industry & contains must contain:
the same information as found in the  Date & time the order (prescription)
drug inserts. was issued.
4. Physician’s Gen Rx published by  Name of drug & whether or not a
Mosby & includes comprehensive generic form of the drug can be
drug information product instituted for a brand-name drug
identification Charts & product  Drug dose
rating by the FDA  Route of administration
5. Handbook of Non-prescription  Frequency & duration of
Drugs – published by the American administration
Pharmaceutical Association &
contains comprehensive information Drug Orders
on OTC drugs including primary  Special instructions such as
minor illnesses the drug is used to withholding or adjusting dosage
treat. based on nursing assessment,
6. Medline Plus – an inline database laboratory results, or drug
produced by the US National Library of effectiveness.
Medicine & National Institutes of  Signature of the prescriber
Health; contains information about the  Signature of the healthcare provider
prescription & OTC drugs & devices as who took the order & transcribed it
well as warnings & drug recall
information. Parts of the Legal Doctor’s Order

DJC
 1. Right assessment
 Name of patient 2. Right documentation
 Date & time 3. Right to education
 Name of drug s 4. Right evaluation
 Dose of drug 5. Right to refuse
 Route of administration Drug Action
 Time or frequency  Is the physiologic interaction
 Signature of the physician between the drug molecule &
molecules in the body that alters a
physiological process of the body.
 3 phases of drug action:
pharmaceutic phase,
pharmacokinetic phase &
pharmacodynamics
Pharmaceutic Phase

Types of Drug Orders

 Routine/Standing order – it is an
ongoing order given for a specific  1st phase of drug action. This phase
number of doses or number of days occurs after the drug is given &
 One-time order – this is a single involves disintegration & dissolution
dose given at a particular time of the dosage form. The drug in solid
 PRN – this is an order to give s form must disintegrate before
medication if specific criteria exist, dissolution, which is the process by
such as h/a, fever, or pain & at a which a drug goes into solution
patient’s request before it becomes available for
 STAT – this is a single order to give absorption.
at once or immediately  2 phases:
a) Disintegration – the breakdown of a
tablet into smaller particles
b) Dissolution – is the dissolving of the
smaller particles in the GI fluid
before absorption
 Rate limiting – is the time it takes
the drug to disintegrate & dissolve to
become available for the body to
absorb it.
10 Rights of Drug Administration Pharmacokinetic Phase
5 traditional right  Is the process of drug movement to
1. Right patient achieve drug action. Four processes:
2. Right drug s a) Absorption – movement of drug
3. Right dose particles from the GIT to body
4. Right time fluids. Three major processes for
5. Right route drug absorption:
5 additional rights o Passive Absorption – occurs mostly
by diffusion (movement from higher

DJC
 concentration to lower making some drug particles unable
concentration) to find a binding site.
o Active absorption – requires a c) Metabolism or Biotransformation
carrier such as an enzyme or protein – drugs may be metabolized in both
to move the drug against the natural the GIT & liver
flow when there is a higher  Half-life (t ½) – the time it takes for
concentration of plasma than there is ½ of drug concentration to be
of drug particles. eliminated. Short half-life – 4 to 8
o Pinocytosis – is the process of hours; longest half-life – 36 hours
engulfing the drug particle & pulling d) Excretion or elimination – main
it across the membrane route is through kidney (urine).
Other routes include hepatic
metabolism, bile, saliva, sweat &
breastmilk.
Pharmacodynamics/Pharmacodynami
c Phase
 Study of drug concentration & its
effect on the body
 Is a drug’s effect on the physiology
of the cell & the mechanism that
causes the pharmaceutical response.
There are 2 effects that a drug
delivers:
a) Primary effect – desirable/ the
b) Distribution – is the process by reason for which the drug is
which the drug becomes available to administered
body fluids & body tissues. Affected b) Secondary effect – is a S/E that may
by three factors: or may not be desirable
o Level of plasma protein – a low Drug’s Time Response
level of plasma protein & albumin  A period of time passes after a drug
might not provide enough binding is administered until the
site for drug particles. This can result pharmaceutical response is realized
in a build up of drugs which can  3 type of time response/ 3
reach to toxic level. parameters of drug action:
Free drugs – not bound to any a) Onset time response/onset of
receptor sites can pharmacological action – is the time for minimum
response. concentration of drug to cause the
o Blood flow – there must be adequate initial pharmaceutical response.
blood flow to target areas of the Some drugs reach the onset time in
body; otherwise, insufficient drug minutes while other takes days.
particles will reach the affected parts b) Peak time response/ Peak of action
of the body. – when the drug reaches its highest
o Competing drugs – 2 drugs blood or plasma concentration.
administered simultaneously might c) Duration of action – is the length of
compete for the same binding sites time the drug has a pharmaceutical
effect.

DJC
 a) Rapid-Cell-Membrane-Embedded
Enzymes – a drug that binds to the
surface of the cell causing an enzyme
inside the cell to initiate a
physiological response.
b) Rapid-Ligand-Gated Ion Channels
– the drug spans the cell membrane
& with this type of receptor, the
channel opens, allowing for the flow
of ions into & out of the cells. The
ions are primarily sodium & calcium
c) G-protein-coupled receptor
systems – there are 3 components to
this receptor response: the receptor;
G protein that binds with guanosine
triphosphate (GTP); the effector that
is either an enzyme or an ion channel
d) Prolonged-Transcriptase Factors –
the drug binds to the transcriptase
factor to undergo a physiological
change.

Receptor Theory
 Referred to as reactive cellular sites
 The pharmaceutical response is
realized when a drug binds to a Agonist
receptor on the cell membrane  A drug that causes a physiological
 The activity of the drug is response
determined by the drug’s ability to  A drug that produces a response
bind a specific receptor Antagonist
 Receptors are protein, glycoproteins,  A drug that blocks a physiological
proteolipids response
 Depending on the drug binding  Drugs that block a response
either initiates a physiological
response by the cell or blocks a cell’s
physiological response
 Receptor Theory
 Receptor are classified into 4
families:

DJC
 the desired pharmaceutical response
& the minimum toxic concentration
Categories of Drug Action (MTC).
 Drugs are categorized by the type of
action it causes on the body. There
are four types of responses:
a) Stimulation or depression – these
are drugs that either increase or
depress cellular activity
b) Replacement – these are drugs that
replace an essential body compound
such as insulin or estrogen
c) Inhibition – these drugs interfere
with bacterial cell & limit bacterial
growth or eliminate the bacteria
d) Irritation – these drugs irritate cells
to cause a natural response that has
therapeutic effect such as a laxative Peak & Trough Levels
that irritate the colon wall or increase  The plasma concentration of a drug
movement of the colon resulting in must be monitored for drugs that
defecation. s have a narrow margin of safety or
Therapeutic Index low TI
 Estimates the margin of safety of a Peak drug level
drug through the use of the ratio that o Is the highest plasma concentration
measures the effective (therapeutic at a specific time
concentration) dose (ED) in 50% of o Indicate the rate of a drug is
persons or animals & the lethal dose absorbed in the body & is affected
(LD) in 50% of animals. by the route used to administer the
 Low therapeutic Index drug – has drug.
a narrow margin of safety; plasma Trough Level
(serum) drug levels need to be o Is the lowest plasma concentration of
monitored because of the small the drug & measures the rate at
safety range between ED & LD. which the drug is eliminated?
 High Therapeutic Index Drug – o Blood should be withdrawn
has a wide margin of safety & less immediately before the next dose is
danger of producing toxic effects; given regardless of the route used to
plasma (serum) drug levels do not administer the drug.
need to be monitored. Loading dose
 Therapeutic Range (Therapeutic  Large initial dose
Window) – plasma drug levels must  When immediate drug response is
be within the therapeutic range; it is desired, a loading dose of a drug is
between the minimum effective given to achieve a rapid MEC in
concentration (MEC) for obtaining plasma
 After a large initial dose, a
prescribed dosage per day is ordered
Side Effects

DJC
 Are physiologic effect other than  Drug dependence – this can be
desired effect either a physical or psychological
 All drugs have s/e, desirable or dependency.
undesirable a) Physical dependency – the patient
 Even with a correct drug dosage, s/e experiences an intense physical
occur & are predictable disturbance when the drug is
Adverse reactions withdrawn
 More severe than s/e b) Psychological dependence – the
 Severe undesirable s/e that occurs patient develops an emotional
unintentionally when a normal dose reliance on the drug
of the drug is given to a patient.  Drug interaction – the
Drugs effects can also be r/t other administration of one drug increases
factors. These include: or decreases the pharmaceutical
 Gender – woman typically are response of a previously
smaller than men & have a different administered drug
proportion of fat & water which  Synergism – a more desirable
affects absorption & distribution of pharmaceutical response is achieved
drugs through the interaction of 2 drugs
 Environment – cold, heat, sensory that are administered
deprivation or overload, & an  Potentiation – concurrent
oxygen deprivation in high altitudes administration of 2 drugs increases
create environmental factors that the pharmaceutical response of one
might interact with a drug. of those drugs
 Time of administration – a drug  Toxic effect – this occurs when the
might be influenced by the presence administered drug exceeds the
or absence of food in the patient’s therapeutic range through an
GIT or by the patient’s corticosteroid overdose or by the drug
secretion rhythm. accumulating in the patient.
 Pathologic state – a drug can react  Tachyphylaxis – the patient build
differently if the patient is tolerance to the drug due to the
experiencing pain, anxiety, frequency in which the drug is
circulatory distress, or hepatic &/or administered.
renal dysfunction. s  Placebo effect – the patient receives
 Idiosyncrasy – this is an abnormal a psychological benefit from
response that is unpredictable & receiving a compound that has no
unexplainable that could result from pharmaceutical response
the patient over responding or under  Pharmacogenetic effect – a drug
responding to the drug or the drug varies from a predicted response
having an effect that is different from because of the influence of a
what is expected. patient’s genetic factor. Genetic
 Tolerance – the patient has factors can alter the metabolism of
decreased physiologic response after the drug & results in an enhanced or
repeated administration of the drug; diminished pharmaceutical response
the drug dosage must be increase to  Allergic reactions – if the patient
achieved the pharmaceutical was previously sensitized to the
response drug, a drug might trigger the

DJC
 patient’s immunologic mechanism 9. Pour liquid at eye level.
that results in allergic symptoms. Meniscus should at the line
 4 types of allergic reactions: of desired dose
1. Anaphylactic – immediate allergic 10. Dilute drugs that irritate
reaction that can be fatal gastric mucosa or give with
2. Cytotoxic reaction – this is an meals.
autoimmune response that result in
hemolytic anemia, thrombocytopenia
or lupus erythematosus (blood d/o)
3. Immune complex reaction – this is Administration
referred to as serum sickness & 1. Administer only drugs that you have
results in angioedema, arthralgia, prepared. Do not prepare
(sore joints), fever, swollen lymph medications to be administered by
nodes & splenomegaly can appear up another.
to 3 weeks after the drug is 2. Identify the client by ID band or ID
administered photo.
4. Cell-mediated – this is an 3. Offer ice chips to numb taste buds
inflammatory skin reaction that is when giving bad-tasting drugs.
also known as delayed 4. When possible, give bad-tasting
hypersensitivity medications first, followed by
pleasant-tasting liquids.
Guidelines for Correct Administration 5. Assist the client to an appropriate
of Medications position, depending on the route of
Preparation administration.
1. Wash hands before preparing 6. Provide only liquids allowed on the
medications. diet.
2. Check for drug allergies: 7. Stay with the client until the
check the assessment history medications are taken.
& the Kardex
3. Check medication order with Administration
health care provider’s order, 1. Administer no more than 2.5 ml to 3
Kardex, medicine sheet, & ml of solution intramuscularly at one
medicine card. site. Infants receive no more than 1
4. Check label on drug ml subcutaneously. Never recap
container three times. needles (universal precaution).
5. Check expiration date on 2. When administering drugs to a group
drug label, card, Kardex; use of clients, give drugs last to clients
only if date is current. who need extra assistance.
6. Recheck drug calculation of 3. Discard needles & syringes in
drug dose with another nurse. appropriate containers.
7. Verify doses of drugs that are 4. Drug disposal is dependent on
potentially toxic with another agency policy & state law. For
nurse or pharmacist. example, discard drugs in the sink or
8. Pour tablet or capsule into the toilet, not in trash can. Controlled
cap of the drug container. substances must be returned to the

DJC
 pharmacy. Some disposals need  Do not give drugs poured by
signatures of witnesses. others.
5. Discard unused solutions from  Do not pour drugs from
ampule. containers with labels that are
Administration difficult to read or whose labels
1. Appropriately store (some require are partially removed or half
refrigeration) unused stable solutions fallen off.
from open vials.  Do not transfer drugs from one
2. Write date & time opened & your container to another.
initials on label.  Do not pour drugs into the hand.
3. Keep narcotics in a double-locked  Do not give medications for
drawer or closet. Medication carts which the expiration date has
must be locked at all times when a passed.
nurse is not in attendance.  Do not guessed about drugs &
4. Keys to the narcotics drawer must be drug doses. Ask when in doubt.
kept by the nurse & not stored in a  Do not use drugs that have
drawer or closet. sediment, are discolored, or are
5. Keep narcotics in a safe place, out of cloudy (& should not be)
reach of children & others in the  Do not leave medications by the
home. bedside or with visitors.
6. Avoid contamination of one’s own  Do not leave prepared
skin or inhalation to minimize medications out of sight.
chances of allergy or sensitivity  Do not give drugs if the client
development. says he or she has allergies to the
Recording drug or drug group.
1. Report drug error immediately to  Do not call the client’s name as
client’s health care provider & to the the sole means of identification.
nurse manager. Complete an incident  Do not give drug if the client
report. states the drug is different from
2. Charting: record drug given, dose, the drug he or she has been
time, route, & your initials. receiving. Check the order.
3. Record drugs promptly after given,  Do not recap needles. Use
especially STAT doses. universal precautions.
4. Record effectiveness & results of  Do not mix with large amount of
medication administered, especially food or beverage or foods that
PRN medications. are contraindicated.
5. Report to the health care provider &
record drugs that were refused with
reason for refusal.
6. Record amount of fluid taken with
medications on input & output chart.
Behaviors to Avoid During Medication
Administration
 Do not be distracted when
preparing medications.

DJC