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C H A P T E R 1: Orientation to Medications Learning Outcomes 1-1 Define terms to understanding administration of medications. 1-2 List the major sources and uses of drugs. 1-3 Define drug standards, indicating how they are determined and why they are necessary. 1-4 List names by which drugs are known. 1-5 List drug references, explain how to use at least one, and make a drug card. 1-6 List the major drug laws and their main features. 1-7 List the federal agencies that enforce the drug laws and the importance of enforcing them. Chapter Outline Key Terms Introduction to Pharmacology Pharmacology Drug Sources Drug Uses Drug Standards Drug Names Drug References Preparing Your Own Drug Cards Drug Legislation You and the Law Chapter Summary Chapter 1 Review Teaching Strategies § Ask students to identify the key terms they are already familiar with. Discuss the definitions of all the terms and be certain that students are clear about the meanings. Point out any similarities that may be confusing to them and tell them to memorize those words to avoid confusion later on. Ask volunteers to share their methods of learning medical key terms. § Ask students to list the major sources of drugs and give examples of each. § If possible, obtain a film from the library or a pharmaceutical company explaining the process of drug trials. Show the film to the class. § Take a field trip to a pharmaceutical company in your area to observe the step-by-step process of manufacturing drugs. Ask students to summarize why, as health care workers, they should understand the drug manufacturing process. Discuss how the company followed drug legislation. § Invite a pharmacist into class (or visit a pharmacy) to discuss the process of testing for generic drugs. Ask students why it is important they understand this process. § Ask a pharmaceutical representative to speak to the class about how he or she can make a difference in patient care. § Visit a local pharmacy or invite a pharmacist into class to discuss what pharmacists teach patients when they dispense a drug. Ask for print material that is sometimes given to patients. Discuss in class how this material could be beneficial or harmful to the patient. § When students begin work in a health facility, ask them to make a list of all the drug references that are available to them in their work environment. Are the materials up-todate? Why are up-to-date references important to the patient and the health care worker? § Ask students to complete the Chapter 1 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with. § Administer and grade the Chapter 1 Test in this Instructor’s Manual. § Develop and administer a performance test for preparing a drug card.

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Critical Thinking Activity You are admitting a patient who frequently changes physicians. The patient has an unlabeled bottle of pills that she has been taking. She says that a doctor she no longer sees prescribed them for her. She does not know why she was taking the drug or the name of the drug. What should you do to determine the drug’s name, action, and therapeutic purpose? Answers to Chapter 1 Review 1. Chemical substance used in the diagnosis, treatment, cure, or prevention of a particular disease 2. The study of drugs: sources, chemical makeup, uses, how to prepare them, and so on 3. The structure of the body and its parts 4. The science that deals with the functions of cells, tissues, and organs of living organisms 5. Rules concerning the strength, quality, and purity of drugs 6. Physicians’ Desk Reference®, a drug reference 7. United States Pharmacopeia/National Formulary, a drug reference containing the standards for official drugs 8. Enforcement agency that enforces the Patriot Improvement and Reauthorization Act of 2005. 9. The absorption, distribution, metabolism, and excretion of drugs 10. Drug sources include: ▪ Plants—digitalis, opium, belladonna, vitamin C, gums, oils ▪ Animals—insulin, heparin ▪ Minerals—iron, iodine, salt, calcium ▪ Synthetic drugs—Bactrim, Septra, biotechnology, Humulin® insulin, vaccines 11. Drug uses: ▪ Prevent diseases—vaccines ▪ Maintain health—insulin, vitamins ▪ Diagnose disease—radiopaque dye, barium ▪ Treat disease—aspirin, antihistamines ▪ Cure disease—antibiotics ▪ Prevent pregnancy—contraceptives ▪ Palliative—chemotherapy 12. Drug laws and agencies: ▪ Pure Food and Drug Act of 1906, no agency ▪ Food, Drug, and Cosmetic Act of 1938, enforced by the FDA ▪ Controlled Substances Act of 1990, enforced by the DEA 13. OTC drugs can be bought and sold without a prescription. Prescription drugs need a doctor’s written or verbal order to be bought and sold. Controlled substances have restrictions on who can prescribe, and how, and how often they can be prescribed. 14. c 15. b 16. a 17. d 18. f 19. e 20. e 21. b 22. a 23. d 24. c 25. b 26. b 27. c. 28. d 29.a 30. Metamucil is a bulk-forming laxative of plant origin. Digitalis is a cardiac glycoside used in the treatment of congestive heart failure. It is also of plant origin. Insulin is used in the treatment diabetes mellitus. It is of animal source. Bactrim is a synthetic drug to treat an infection. Iron is a mineral given as a supplement generally for a deficiency in the diet. 31. Nitroglycerin is the generic name and Nitrostat is the brand name. A healthcare provider may order a drug by either a generic or brand name. A generic name allows the pharmacist to dispense from nonbrand name drugs. A drug only has one generic drug name but may have several brand names. For example, nitroglycerin has the other brand names of Nitro-bid or Nitrong. Gauwitz, Administering Medications, 8e

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Although memorizing all the generic and brand names for drugs is not possible, be familiar with both the generic and brand names. 32. Janie should study the federal and state laws controlling medication administration. She should also study the nursing home’s own regulations, and she should find out who is in charge so that she knows to whom questions should be addressed. 33. Answers will vary 34. White 35. About 17 (this will vary from year to year) 36. Acetaminophen 37. Answers will vary

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C H A P T E R 2: Principles of Drug Action Learning Outcomes 2-1 Identify the basic drug actions and the body processes that affect drug actions. 2-2 Identify the factors influencing drug action. 2-3 Distinguish between systemic and local drug effects. 2-4 Summarize the differences between therapeutic effect, side effects, synergism, antagonism, and potentiation. 2-5 Explain the difference between psychological and physical drug dependence.. . Chapter Outline Key Terms Pharmacokinetics Drug Action Factors Affecting Drug Action Drug Effects Adverse Reactions Drug Dependence or Drug Abuse? Chapter Summary Chapter 2 Review Teaching Strategies ▪ Discuss the definitions of the key terms and have the students give an example of how each term is used. ▪ Ask students to use a drug reference to find side effects that are not adverse reactions. This activity is more meaningful if you select a drug one of the students is taking or has recently taken. ▪ Obtain and show a film on drug addiction. Ask the students to summarize the difference between physical and psychological dependence. ▪ Make arrangements for the class to visit a community-based psychiatric hospital or clinic to observe patients who have been abusing drugs. ▪ Arrange for a panel discussion to include drug counselors, crisis center ▪ workers, former addicts, and alcoholics to provide the students with the opportunity to obtain firsthand knowledge from the victims of abuse. ▪ Ask students to attend an AA meeting and write a summary of the experience. Also ask them to bring back any literature that is available. ▪ Discuss the potential of drug abuse in health care workers. Discuss what is the worker’s responsibility if he or she suspects a fellow health care worker to have a drug abuse situation. ▪ Develop a class discussion on how a health care worker might help a drug-impaired health care worker. ▪ Have students work in cooperative learning groups to make a display that describes the local and systemic processes of drug effects in the body. ▪ Ask students to explain the difference between synergism, antagonism, and potentiation. ▪ Divide students into two cooperative learning groups. Identify five drug categories. After group one has identified the therapeutic effects of those identified drugs and group two has identified the side effects of the same drugs, have a class discussion on the differences. ▪ Ask students to complete the Chapter 2 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with. ▪ Administer and grade the Chapter 2 Test in this Instructor’s Manual. Critical Thinking Activity Have each student imagine caring for a patient who started on a new drug a week ago and was given information on the side effects of that medication. The patient now says that he is Gauwitz, Administering Medications, 8e

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experiencing all of the side effects mentioned a week ago. Ask the student to consider if the patient is suggestible or really suffering from the side effects of that drug. Ask the student what should be done. Answers to Chapter 2 Review 1. The study of a drug during absorption, distribution, metabolism, and excretion 2. Effects 3. Passage of a substance into the bloodstream from the site of administration 4. Movement of drugs into cells and into spaces between cells 5. Breaking down drugs into different substances that can be excreted 6. Removal of waste products from the body 7. Systemic 8. Local 9. Speeding up (stimulating), slowing down (depressing), stopping or destroying 10. Replacing 11. Absorption, distribution, biotransformation, excretion 12. Kidneys, large intestine, lungs, milk glands 13. Therapeutic and side effects 14. Any three of the following: skin rashes, itchy eyes, itchy skin, wheezing, fever, nasal drainage 15. An inactive substance that has no pharmacological effect 16. Self-administration of a drug in chronically excessive amounts resulting in psychological and/or physical dependence 17. Overuse or improper use of any drug 18. Abnormal or peculiar response to certain drugs 19. Five of the following: narcotics and opium; barbiturates, sedatives or hypnotics, and alcohol; amphetamines, cocaine, and other stimulants; LSD and other hallucinogens; marijuana 20. Consult the nurse in charge. 21. A condition in which the body must have a drug in order to function because it is so used to having the drug 22. A feeling of being unable to get along without a drug 23. Dose of a drug that is too large for the patient’s size, age, or physical condition 24. Symptomatic and supportive 25. Laxative, acetaminophen, aspirin, nicotine, alcohol 26. Breathing and heart stop. 27. Shortens the time needed for symptoms to appear; potentiates the effect of the drug 28. Drug that has the opposite effect and can reverse the overdose symptoms 29. — 30. 31. — 32. 33. 34. 35. — 36. — 37. 38. 39. 40. 41. 42. 43. 44. — 45. 46. — 47. — 48. b 49. c 50. a 51. a 52. d 53. Absorption is the passage of a drug from the site of administration into the bloodstream. Subcutaneous drug such as insulin is injected just below the skin. It is absorbed slowly. For example, slower than an intramuscular drug. 54. Increase fluids Avoid taking laxatives because they speed up the drug excretion Improper diet and lack of exercise slow drug excretion After general anesthesia, coughing and deep breathing help eliminate the anesthesia more quickly Keep the skin clean to avoid irritation from drugs eliminated through the sweat glands Chew gum or suck hard candy, such as lemon drops, to decrease the unpleasant effects of drugs eliminated through the saliva Gauwitz, Administering Medications, 8e

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If pregnant, discuss all drugs including over-the-counter drugs with their physicians to avoid the possible risk to the fetus 55. Tolerance 56. Cumulative effect 57. Potentiation (or synergism) 58. Drug dependence 59. Antagonism 60. Idiosyncrasy 61. Drug allergy 62. Drug interaction 63. Overdose 64. Adverse Event Report 65. In back of PDR® and is allowed to be copied 66. Vaccine Adverse Event Reporting System 67. To compare it with the patient’s history and the conditions at hand

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C H A P T E R 3: Measurement and Dosage Calculations Learning Outcomes 3-1 Solve problems utilizing fractions and decimals. 3-2 Identify the most common equivalents among apothecary, metric, and household measures 3-3 Solve Fahrenheit to Celsius temperature conversion and vice versa. 3-4 Calculate the number of tablets, capsules, and injectable medications to give when the available dose differs from the ordered dose. 3-5 Calculate a child’s dose of medication. 3-6 Calculate drops per minute for IV therapy. Chapter Outline Key Terms Math Review: Fractions Systems of Measurement Converting Among Measurement Systems Dosage Calculation Chapter Summary Chapter 3 Review Teaching Strategies ▪ Discuss the meanings of the key terms. Be sure students understand all of the terms before proceeding. ▪ Ask students to make cards, posters, flashcards, or displays that can be used to help them learn the abbreviations and equivalents found in Tables 3-1 through 3-7 in the text. ▪ Encourage students to share their learning tools and to use them as needed. ▪ Calculate dose using a procedure for converting between different units of measurement. ▪ Set up stations in the lab to resemble a patient room, a medicine room, and an emergency cart that includes IV equipment. At each station arrange appropriate forms of medications with dosage labels. Make cards that require students to calculate the proper dosage. On the back of the cards place the answers. Have students in groups or individually go to each station and calculate the various dosages. Ask them to repeat any of the calculations they missed. ▪ Perform a calculation relay race. Divide the students into two equal lines and line them up in front of the bulletin board. Have medication calculations on index cards. Give the first student a card to work the calculation as quickly as possible on the blackboard. It the student cannot get the answer only the second student can help the first student. When the student gets the answer, the second student gets a card. Repeat the process through all the students. ▪ Ask students to complete the Chapter 3 Review. Discuss answers, clearing up any misconceptions students may have. Review any material students had difficulty with. ▪ Administer and grade the Chapter 3 Test in this Instructor's Manual. Critical Thinking Activity Calculate a dose of medication to be administered to a patient intramuscularly. When you go to give the medication, the patient says the syringe you are using is too big and contains more medicine than usual. What should you do? Answers to Chapter 3 Review 1. The different amounts of a drug that will produce therapeutic effects but not serious side effects or toxicity 2. Basic unit of weight in the apothecary system 3. A decimal system of measurement in which the basic unit of length is the meter, the basic unit of volume is the liter, and the basic unit of weight is the gram 4. Basic unit of volume in the apothecary system Gauwitz, Administering Medications, 8e

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5. Basic unit of volume in the metric system 6. Basic unit of length in the metric system 7. A mathematical way of talking about an amount that is part of a whole or a ratio between two numbers 8. One-hundredth of a meter 9. One-thousandth of a liter, the same as a cubic centimeter 10. The bottom number of a fraction 11. A fraction in which the value of the numerator is greater than or equal to the value of the denominator. The value of the improper fraction is greater than or equal to 1. 12. a 13. a 14. b 15. a 16. b 17. Min 18. gr 19. dr 20. fldr 21. oz 22. gtt change to gt 23. pt 24. T, tbsp 25. lb 26. mg 27. mL 28. L, l 29. g, gm 30. 4 fluidrams 31. 1 1⁄2 grains 32. 2 minims 33. 9 fluidrams 34. One 35. One 36. 15 37. 1 38. 60 39. 1000 40. One 41. 500 42. One 43. ½ 44. 1/3 45. ¾ 46. ¾ 47. ¼ 48. 5/9 49. 2 2/3 50. 2 ½ 51. 1 5/12 52. 2 ¾ 53. 4 ½ 54. 22 2/3 55. 3 ½ 56. 5 2/5 57. 3/100 58. 1 ¼ 59. 4 1/6 gr 60. 5/12 61. 1 11/24 62. 180 mg 63. ¾ 64. 1/180 65. 1 1/8 66. 600 67. 0.5 68. 0.25 69. 0.75 70. 0.25 71. 0.023 72. 0.333 73. 0.667 74. 0.6 75. 0.89 76. 3.75 77. ¾ 78. 1 ½ 79. 1/200 80. 1/5 81. 5 2/3 82. 3/8 83. 4.5 84. 0.045 85. 0.3 86. 0.45 87. 0.275 88. 3 89. 100 90. 30 91. 0.325 92. 3 93. 2500 94. 125 95. 1.2 96. 0.005 97. 36.3º 98. 37.2º 99. 37.8º 100. 38.8º 101. 38.9º 102. 40º 103. 95.8º 104. 99.3º 105. 102.6º 106. 104º 107. 105.6º 108. 107.6º 109. 68.2 110. 39.1 111. 49.5 112. 106.3 113. 99 114. 3.64 115. 35.2 116. 70.4 117. 176 118. 11 119. 206.8 120. c 121. a 122. c 123. d 124. a 125. All numbers less than 1 must be documented with a zero prior to the decimal point. A math problem must always be labeled with the appropriate unit of measure. All weights must be rounded to the tenth place. Round medications to the hundredth place. If the last number in rounding is less than 5, round down. If the last number in rounding is greater than 5, round up. 126. Assumed the vehicle (V) is one when it may be greater for example two. Always double check the vehicle to correctly determine it before setting up your calculation. 127.1/600 131. 2 ½ 135.

128. 1/120 132. 300

129. 1 133. 15

130. 1/15 134. 0.5

D X = H V

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50 g X = 100 g 1 ml 100X = 8 50 ÷ 100 = 0.5 mL X = 0.5 mL 136.

D X = H V 8,000 units X = 10,000 units 1 ml 10X = 8 8 ÷ 10 = 0.8 mL 137.

X D = V H Conversion is 1 g = 1000 mg

600 mg X = 600 mg 1 tablet 600X = 600 600 ÷ 600 = 1 X = 1 tablet 138.

X D = V H 12.5 mg X = 1 tablet 25 mg 25X = 12.5 12.5 ÷ 25 = 0.5 X = ½ tablet 139.

D X = H V 450,000 units X = 300,000 units 1 mL 45 X = 30 1 45 ÷ 30 = 1.5 mL X = 1.5 mL 140.

D X = H V Gauwitz, Administering Medications, 8e

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20 mg X = 25 mg 2 mL 25X = 40 40 ÷ 25 = 1.6 X = 1.6 mL 141.

D X = H V 3 mg X = 4 mg 1 mL 4X = 3 3 ÷ 4 = 0.75 X = 0.75 mL 142.

X D = V H 3,000 mg X = 10,000 mg 1 mL 3 X = 10 1 10X = 3 3 ÷ 10 = 0.3 X = 0.3 mL 143.

X D = V H 400 mg X = 500 mg 2.5 mL 4 X = 5 2.5 5X = 10 10 ÷ 5 = 2 X = 2 mL 144.

X D = V H 15 mg X = 10 mg 1 mL 3 X = 10 1 10X = 15 Gauwitz, Administering Medications, 8e

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15 ÷ 10 = 1.5 X = 1.5 mL 145.

D X = H V 600 mg X = 120 mg 5 mL 120 X = 3,000 12X = 300 300 ÷ 12 = 25 25 mL 146.

X D = V H Conversion is 1 g = 1000 mg

1.5 g X = 0.75 g 1 tablet 0.75X = 1.5 1.5 ÷ 0.75 = 2 X = 2 tablets 147.

X D = V H 6,000 units X = 10,000 units 1 mL 6 X = 10 mL 10X = 6 6 ÷ 10 = 0.6 mL X = 0.6 mL 148. Change 0.75 g to mL 3 mL of the prepared solution = 1 g The equivalent fraction = 0.75 g X

3 mL 1g

3 mL = 2.25 mL 1g

2.25 mL of the prepared solution contains 0.75 g of Mefoxin 149.

D X = H V Gauwitz, Administering Medications, 8e

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75 mg X = 100 mg 2 mL 100X = 150 150 ÷ 100 = 1.5 X = 1.5 mL 150. Demerol

D X = H V 60 mg X = 100 mg 2 mL 100X = 120 120 ÷ 100 = 1.2 X = 1.2 mL Vistaril

25 mg X = 25 mg 1 6 X = 10 mL 25X = 25 25 ÷ 25 = 1 X = 1 mL Demerol 1.2 mL and Phenergan 1 mL is a combined does of 2.2 mL Demerol and Phenergan are compatible and may be administered in one syringe.

151.

X D = V H 500 mg X = 5 250 mg 6 X = 10 mL 25X = 250 250 ÷ 25 = 10 X = 10 mL 152.

D X = H V 0.3 mg X = 0.3 mg 1 mL 0.3 X = 0.3 0.3 ÷ 0.3 = 1 X = 1 mL Gauwitz, Administering Medications, 8e

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