HENRY FORD HEALTH SYSTEM
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
1
HENRY FORD HEALTH SYSTEM
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
Affiliated Schools/Pharmacology guide/2017/2020
TABLE OF CONTENTS
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Pharmacology Study Guide for RN Clinical Instructors at Henry Ford Health System, Study notes of Pharmacology
This study guide provides guidelines for medication administration, including the Six Rights of Medication Administration, drug dosage calculations, and cultural considerations. It also includes information on various drug categories and herbal supplements. The guide emphasizes the importance of knowing each drug and using resources to obtain information. The guide is affiliated with Henry Ford Health System and was last updated in 2020.
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RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
HENRY FORD HEALTH SYSTEM
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
Affiliated Schools/Pharmacology guide/2017/
TABLE OF CONTENTS
RN CLINICAL INSTRUCTOR
- EXAMINATION GUIDELINES PHARMACOLOGY STUDY GUIDE
- EXAM OUTLINE
- SIX RIGHTS OF MEDICATION ADMINISTRATION
- VERBAL / TELEPHONE ORDERS
- RANGE ORDERS
- CULTURAL CARE CONSIDERATIONS
- AGE-BASED CONSIDERATIONS
- DRUG DOSAGE CALCULATIONS
- FORMULAS FOR IV RATE CALCULATION
- MEDICATION WORKSHEET: PRACTICE PROBLEMS
- ANSWER KEY: PRACTICE PROBLEMS
- ANTI-INFECTIVE DRUGS
- CARDIOVASCULAR DRUGS
- CENTRAL NERVOUS SYSTEM DRUGS
- RESPIRATORY TRACT DRUGS
- GASTROINTESTINAL DRUGS
- HORMONAL DRUGS
- AGENTS FOR FLUID AND ELECTROLYTE BALANCE
- HERBAL SUPPLEMENTS / ALTERNATIVE THERAPIES
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
GENERAL PHARMACOLOGY EXAM OUTLINE
- Review the six rights of medication administration
- Review IV drip rate calculations and calculations of drug dosages
- Review action/use, common side effects and nursing responsibilities, including patient education, related to common drugs used on general practice units
- Complete the practice questions
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
When administering medications with students, the faculty must know the following.
Six Rights of Medication Administration
1. Right Drug Proper identification of the ordered drug is required. Check medication against the physician’s order form. As a Registered Nurse, you have the responsibility before administering any medication, to ensure that the dose and drug is appropriate for the patient. You also have the responsibility to clarify orders, which are unclear or seem inappropriate for the clinical condition of the patient. 2. Right Dose The RN is responsible for checking the dosage of the drug, doing the appropriate calculations or conversions, and knowing the usual dosage. 3. Right Patient Proper identification of the patient is required before medication is administered. HFHS’s acceptable method for confirming identification consists of checking the patient’s first and last name and medical record number (MRN) on the identification band with the name and MRN on the Medication Administration Record (MAR). 4. Right Route Route of administration should be part of the physician’s order. The RN is responsible for preparing and administering medications correctly by consulting the accompanying instructions from the pharmacy or drug company**.
- Right Time** The RN is responsible for administering medications according to scheduled times if that is how the order is written. Instructing patients on the timing of self- administered drugs at home is also an important function for nurses. Instruct using exact times such as “take at 8:00 in the morning with food and 5:00 in the evening with food” rather than “take at meal times” since meal times can vary with different cultural groups. 6. Right Documentation The RN is responsible for documenting the administration of the prescribed medication with the information required in the appropriate location such as the Medication Administration Record (MAR) within the Electronic Health Record.
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
Abbreviations that should NOT be used
Do not use these dangerous abbreviations or dose designations
Abbreviation/ Dose Expression
Intended Meaning Misinterpretation (^) Correct Usage
cc Cubic centimeter Mistaken for U (units) when poorly written
Write “mL” for milliliters Q.D. Once^ daily^ Mistaken^ for^ Q.O.D.^ Write “daily” Q.O.D. Every other day Spell out “every other day” S.C. or S.Q. For subcutaneous Mistaken as SL for sublingual or “5 every”
Write “Sub-Q”, “subQ”, or “subcutaneously” Trailing zero (X. mg), lack of leading zero (.X mg)
Decimal point is missed (^) Never write a zero by itself after a decimal point (X mg), and always use a zero before a decimal point (0.X mg)
U Units^ Mistaken^ for^ a^ zero, resulting in a ten-fold dosing overdose
Spell out “units”
Ug Microgram Mistaken for mg (milligrams) resulting in one thousand-fold dosing overdose
Spell out “microgram or “mcg”
& And^ Spell out “and” IU International Unit Mistaken as IV (Intravenous) Or 10 (ten)
Write out “international unit”
Drug Names
No abbreviated drug names are allowed i.e. HCTZ, MOM
All drug names Spell out complete drug name
MS or MS04 Morphine sulfate Write out “morphine sulfate” MgSO4 Magnesium sulfate Write “magnesium sulfate” *Approved by the HFHS Pharmacy and Therapeutics Committee 12/
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
Patient Education
Patients need to know
- the names of medications and how to pronounce them
- what the medications do
- what they look like
- how and when medications should be taken
- possible side effects and food/drug interactions
Patients should be encouraged to carry a list of their medications with doses and schedule with them at all times. Patients may have difficulty following the medication treatment plan due to language barriers, low literacy, poor eyesight, memory problems, cultural beliefs, and/ or inability to afford the cost of medications. Patients should be screened for the presence of these barriers during the admission process and they should be considered in the discharge plan.
Medications Requiring Special Care (High Alert Medications)
High alert medications are drugs that bear a higher risk of causing significant patient harm when they are used in error. Some examples of these medications include: potassium chloride, heparin, warfarin, insulin, calcium, chemotherapy drugs, opioids, and lidocaine. These high alert medications may require special safeguards to reduce the risk of errors, including double checks, limiting access and standardization. Identify the medications requiring special care during the time you are on your unit.
Verbal Orders for Medications
Students and faculty are not to receive verbal orders.
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
Range Orders continued
If supplemental symptom relief is needed prior to the next approved frequency (e.g. before 4 hours) in the “every 4 hours” frequency and side-effects are tolerable, an additional dose may be given prior to the next dosing interval time, provided the total dose does not exceed the maximum prescribed dose.
For example: Order reads, “Morphine sulfate 2-8mg IV push every 4 hours” Morphine 2 mg is given at 1200, without relief and without side effects. At 1300, an additional 2mg IVP is given for a total of 4mg. A supplemental dose is required at 1500. Since only 4mg has been given, 4mg more may be given at this time for a total of 8mg within the 4 hour limit. At 1800, the patient requires another dose of morphine. The total received within the last 4 hours (1400-1800) is 4mg. Therefore, the nurse may consider administering up to 4mg of morphine at this time. Any larger dose will exceed 8mg within the 4 hour limit.
Hour 1100 1200 1300 1400 1500 1600 1700 1800 1900
Morphine sulfate doses given
2 mg
2 mg
Up to 4 mg may be given
The total amount of morphine sulfate given in the 4 hour period prior to 1500 hours = 4 mg, so up to 4 mg may be given at 1500 hours.
Up to 4 mg may be given
If 4 mg were administered at 1500 hours, the total amount of morphine sulfate administered in the 4 hour period prior to 1800 hours = 4 mg, so up to 4 mg may be given at 1800 h
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
Cultural Care Considerations
Patients may hold different views on:
- The definition of “family”
- The meaning of birth and death
- The cause of their illness
- Acceptable communication such as eye contact & touch
- The acceptability of asking direct questions of healthcare personnel
- The use of “Healers” and when to seek professional medical help
- The use of traditional remedies versus prescribed medication
- The meaning of pain and the accepted response to pain
- Immunizations and other preventive health measures
- Eating certain foods
- The importance of religion and religious practices
- The accepted response to loss and grieving
Cultural differences can affect the acceptance of the medication plan by the patient/family, especially these highlighted beliefs.
Nursing Assessment & Intervention
- Talk with the patients/families about their beliefs and practices as they relate to taking medications
- Assess their use of traditional remedies and views on prescribed medications
- Discuss with the physician and the pharmacist if issues are identified
- Develop an education plan in collaboration with the physician and the pharmacist
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
Drug Dosage Calculations
Metric Equivalents: 1 kilogram = 1000 grams 1 milligram = 1000 mcg 1 gram = 1000 mg 1 liter = 1000 ml
Conversions within the metric system:
Hint: Big to small: Multiply Small to Big: Divide gm to mg mg to gm ♥ Multiply by 1000 or move ♥Divide by 1000 or move decimal decimal point 3 places to the right. point 3 places to the left Bigger to smaller unit– go right Smaller to bigger unit– go left
L to ml ml to L ♥Multiply by 1000 ♥Divide by 1000
mg to mcg mcg to mg ♥Multiply by 1000 ♥Divide by 1000
Conversions from one system of measurement to another: 1 kilogram = 2.2 lb 1 tbsp = 15 ml 1 ounce = 30 ml
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
Conversions from One Measuring System to Another
New equivalent (what you want) X Known Unit = conversion Old equivalent (what you have)
Examples
Convert 143 pounds to kilogram: 1 kg X 143 = 65 kg 2.2 lb
Convert 50 kilograms to pounds: 2.2 lb X 50 = 110 lb 1 kg
Convert 800 grams to kilograms: 1 kg X 800 = 0.8 kg 1000 gm
Convert 120 milliliters to teaspoons: 1 tsp X 120 = 24 tsp 5 ml
Convert 6 ounces to milliliters: 30 ml X 6 = 180 ml 1 ounce
Convert 930 milliliters to ounces: 1 ounce X 930 = 31 ounces 30 ml
Convert 0.7 grams to milligrams 1000 mg X 0.7 = 700 ml 1 gram
Convert 2 milligram to micrograms 1000 mcg X 2 = 2000 mcg 1 mg
Convert 3 tsp to ounces 1 ounce X 3 = 0.5 ounces 6 tsp
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
Formulas for IV Rate Calculation
In order to calculate the continuous drip rate for an IV infusion the following information is necessary:
a. amount of solution to be infused b. amount of time during which the solution is to be infused c. drop factor for the tubing used (found on tubing package)
total volume to be infused x drop factor (gtts/ml) = gtt/min total hours for infusion x 60 min/hr
Example : Infuse 1000 ml D5W/0.45 NaCl over 8 hours using tubing with a drop factor of 10 gtts/min.
1000 ml x 10 gtts = 1000 = 20.8 or 21gtts/min 8 hr 60 min 48
For intermittent infusions such as antibiotic piggybacks, use the following formula:
Total volume to be infused x drop factor = gtts/min Total minutes
Example : Administer 3 gm Zosyn in 100 ml D5W over 45 minutes using tubing with a drop factor of 15 gtts/min
100mL x 15 = 33.5 gtts/min 45min
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
Medication Worksheet: Practice Problems:
Equivalents
**1. 0.25 Gm = ___________mg 7. 250 ml = ______________L
- 100 lb = ___________ kg 8. 2 L = ______________ml
- 2 Gm = ___________mg 9. 0.4 mg = ______________mcg
- 125 mg = ___________Gm 10. 0.125 mg = ____________mcg
- 750 mg = ___________Gm 11. 200 mcg = ____________mg
- 90 kg = ___________lb 12. 250 mcg = ____________mg**
Dosage Problems:
- Order: Acetaminophen liquid 180 mg PO now Label: Acetaminophen liquid 120 mg per 5 ml Administer: ____________________________________
- Order: Cephalexin 375 mg PO now Label: Cephalexin suspension 125 mg per 5 ml Administer:____________________________________
- Order: Clonidine 0.2 mg PO now Label: Clonidine 100 mcg tablets Administer:____________________________________
- Order: Erythrocin Stearate 0.75 Gm PO now Label: Erythrocin Stearate 250 mg tablets Administer:____________________________________
- Order: S-R Penicillin 1,000,000 units IM now Label: S-R Penicillin 600,000 units per 1 ml. Administer:____________________________________
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
Available: 750 mcg scored tablets. Administer: ____________________________________
- Order reads: Digoxin elixir 0.125 mg PO every morning. Available: Digoxin elixir 50 mcg (0.05 mg) per ml. Administer: ____________________________________
- A medication is available as a powder to be reconstituted with 8.6 ml of diluent resulting in a concentration of 100 mg/ml. If 375 mg is ordered how many milliliters of the reconstituted solution should a nurse administer? Administer: _____________________________________
RN CLINICAL INSTRUCTOR
PHARMACOLOGY STUDY GUIDE
IV Calculations and IV Medications
- Order reads: 1000 ml D5W with 20 mEq KCL q 12h. Calculate the drops/minute using macro drip tubing (10 gtts/ml). Answer: _______________________
- Order reads: 1000 ml D5W q 24h at a KVO (keep open rate). Calculate the drop rate using micro drip tubing (60 gtts/ml) is used. Hint: KVO = 42 ml/hr Answer: _______________________
- Order reads: 500 ml D5 and 0.33 Sodium Chloride, with 1 ampule of MVI q 24 h. Calculate the drop rate per minute using micro drip tubing (60 gtts/ml). Answer: ________________________
- Order reads: Ampicillin 500 mg IVPB q 6 hrs in 100 ml D5W. Drop factor for the secondary administration set is 10 gtts/ml. Calculate the drop rate per minute administering the medication over 30 minutes Answer: ________________________ Calculate the drop rate per minute administering the medication over 45 minutes. Answer: ________________________
- The piggyback has a total volume of 50 mLs. The medication is ordered to be infused over 30 minutes (drip factor = 10 gtts/ml). How many drops per minute would you infuse? Answer: ________________________
- A heparin drip is ordered. The heparin bag is 25,000 units in a 250 ml bag of D5W. What is the concentration of heparin per mLs? Answer: _________________________
- Order reads: 1000 mL of Normal Saline to infuse over 10 hours. If the RN starts the infusion at 0800, how many milliliters are left to count in the bag at 1300? Answer: _________________________
- The physician orders 1 unit of packed cells to infuse over 2 hours. The unit is marked to contain 300 ml. Calculate the flow rate in ml/hr. Answer: _______________________