The 12 Rights of Medication Administration are 7.

Right Reason/Indication
fundamental principles that guide healthcare - Administer medication for the appropriate
professionals, especially nurses, in ensuring safe condition and indication for which it was
and accurate medication practices. Adhering to prescribed. Understanding the purpose of the
these rights helps prevent medication errors, medication prevents unnecessary administration.
enhances patient safety, and maintains the standard
of care in healthcare settings. 8. Right Assessment
- Perform a patient assessment before administering
1. Right Patient medication. Evaluate the patient’s vital signs,
- Ensure that the medication is intended for the allergies, current condition, and previous responses
correct individual by verifying their identity using to medications.
at least two unique identifiers (e.g., name, date of
birth, medical record number). 9. Right Education
- Educate the patient about the medication,
2. Right Medication including its purpose, potential side effects, and
- Confirm that the medication ordered matches what how to take it properly. Encourage questions and
is being administered by checking the medication ensure comprehension.
label against the medication administration record
(MAR). This includes verifying the drug name, 10. Right to Refuse
strength, and form. - Respect the patient's right to refuse medication.
Inform them of the potential consequences of
3. Right Dose refusing but never force the administration against
- Administer the prescribed dosage accurately, their will.
ensuring it is appropriate for the patient's age,
weight, and condition. Calculations should be 11. Right Evaluation
double-checked for accuracy. - Evaluate the patient’s response to the medication
after administration to ensure effectiveness and
4. Right Route monitor for any adverse reactions.
- Administer the medication via the correct route as
ordered by the healthcare provider (e.g., oral, 12. Right to Documentation of Education
intravenous, intramuscular, etc.) and according to - Document the patient education provided
the medication's specifications. regarding the medication, including details of what
was discussed, questions answered, and any
5. Right Time educational materials provided.
- Administer medication at the scheduled time or
within the prescribed timeframe to maintain its Adhering to these rights helps safeguard against
therapeutic effect. Ensure the interval between medication errors, promotes patient-centered care,
doses is appropriate. and ensures comprehensive and safe medication
practices in healthcare settings. Nurses and other
6. Right Documentation healthcare professionals should be diligent in
- Record all medication administrations accurately applying these rights during every step of the
and promptly in the patient's medical records. medication administration process.
Document the date, time, dosage, route, and site of
administration.
Patient Safety and Medication
Administration
Patient safety is a paramount concern in healthcare,
especially regarding medication administration. 2. Use of Technology:
Nurses play a critical role in ensuring safe and - Leverage technology such as barcode scanning
effective medication practices to prevent errors and and electronic medication administration records
enhance patient well-being. Several key aspects (eMARs) to reduce errors in medication
contribute to patient safety in medication administration.
administration:
3. Ongoing Education and Training:
1. Verification and Identification: - Continuous education and training for healthcare
- Confirm the patient's identity using at least two staff on new medications, potential side effects, and
identifiers before administering any medication. updated protocols.

2. Accurate Documentation: 4. Open Communication:

- Maintain accurate and timely documentation of - Foster an environment where healthcare
all medication administrations, including the drug professionals feel comfortable reporting errors
name, dosage, route, time, and any observed without fear of retribution, allowing for shared
effects. learning from mistakes.

3. Medication Reconciliation: 5. Patient Involvement:

- Ensure a complete and accurate list of the - Engage patients in their care by encouraging
patient's medications, including prescribed drugs, them to ask questions, understand their
over-the-counter medications, and supplements. medications, and be active participants in their
treatment plans.
4. Double-Check Protocols:
- Implement double-check procedures, 6. Periodic Reviews and Audits:
particularly for high-risk medications or situations, - Regularly review medication administration
involving another nurse verifying the medication processes and conduct audits to identify any
prior to administration. potential areas for improvement.

5. Proper Dosage Calculations:

- Accurately calculate medication dosages and Importance of Error
administer them within the safe range, particularly
in pediatric and geriatric patients who may need
Reduction
adjusted dosages.
Reducing medication errors is crucial as these
6. Awareness of High-Alert Medications: errors can lead to adverse outcomes, compromised
- Exercise extra caution when dealing with high- patient safety, and increased healthcare costs.
alert medications, such as narcotics or Patients can experience harm or adverse reactions
anticoagulants, to prevent errors. due to medication errors, impacting their recovery
and overall well-being.
Error Prevention Strategies
In conclusion, prioritizing patient safety in
1. Standardized Protocols: medication administration involves a multifaceted
- Follow established protocols and best practices approach that combines best practices, error
when administering medications, adhering to clear prevention strategies, ongoing education, and a
guidelines and policies. commitment to continuous improvement. Nurses, as
frontline caregivers, play a pivotal role in upholding
these standards to ensure the safety and well-being
of the patients they serve.
Patient Education 7. Interactions and Precautions:
- Discuss potential drug interactions with other
Patient education regarding medications is a crucial medications, supplements, or foods, and advise on
aspect of nursing care, aiming to empower patients precautions to take while on the medication (e.g.,
with knowledge about their prescribed medications, avoiding alcohol or specific activities).
ensuring understanding, adherence, and ultimately
improving health outcomes. Here's a 8. Written Materials:
comprehensive guide for patient education: - Provide written materials, such as leaflets or
handouts, summarizing key points about the
1. Clear Communication: medication for patients to reference later.
- Use plain language and avoid medical jargon to
explain the purpose of the medication, its benefits, 9. Encourage Questions:
and how it works. - Create an open dialogue, encourage questions,
and address any concerns the patient might have
2. Dosage and Administration: regarding the medication.
- Provide explicit instructions on how to take the
medication, including dosage, frequency, and 10. Follow-Up:
specific administration instructions (e.g., with food, - Schedule follow-up appointments or check-ins
at certain times of day). to assess the patient's response to the medication
and address any further questions or concerns.
3. Potential Side Effects:
- Explain common side effects and adverse
reactions that patients might experience,
Regulatory and Legal
emphasizing when to contact a healthcare provider Considerations
and when to seek immediate medical attention.
Regulatory and legal considerations play a crucial
4. Duration of Treatment:
role in medication administration within the realm
- Clarify the duration for which the medication
of nursing. Adherence to these guidelines is
should be taken and the importance of completing
fundamental to maintaining patient safety,
the full course even if the patient starts feeling
upholding ethical standards, and ensuring
better.
compliance with established laws and regulations.
5. Missed Doses:
From a regulatory standpoint, nurses must follow
- Educate patients on what to do if they miss a
the standards and guidelines set forth by regulatory
dose, and whether they should take it immediately
bodies, such as the Joint Commission and the Food
or skip it and continue with the next scheduled
and Drug Administration (FDA). Compliance with
dose.
these standards, along with adherence to facility-
specific policies and protocols, is essential.
6. Storage and Disposal:
Accurate and timely documentation of medication
- Instruct patients on proper storage conditions for
administration, encompassing patient records and
medications (e.g., room temperature, away from
medication administration records, is imperative to
moisture or direct sunlight), and proper disposal
meet regulatory requirements.
methods.
Additionally, engaging in continuing education
ensures nurses stay abreast of evolving regulatory
changes, maintaining compliance with new
standards.
Legally, nurses must work within the defined scope Uses: These agents are used to treat heart failure,
of practice delineated by their nursing licensure, atrial fibrillation, and certain arrhythmias.
which determines their responsibilities in Side effects: Common side effects include nausea,
medication administration. Ensuring informed vomiting, headache, and dizziness. It is important to
consent from patients before administering monitor for signs of toxicity, such as changes in
medications is a legal and ethical obligation. Nurses heart rate or rhythm.
are held accountable for their actions and decisions, Nursing responsibilities: Nurses should monitor
emphasizing the importance of meticulous vital signs, electrolyte levels, and cardiac function.
adherence to protocols and proper documentation. They should educate patients about the medication's
Reporting and documentation of medication errors purpose, dosage, and potential side effects.
are critical in accordance with facility policies and
legal requirements to ensure transparency, facilitate Side effects: In toxic doses, dysrhythmias may
improvements in healthcare processes, and mitigate occur, including supraventricular tachycardia, atrial
liability in case of adverse events. fibrillation, atrial flutter, multifocal atrial
tachycardia, ventricular tachycardia, and ventricular
Confidentiality of patient information regarding fibrillation. Dysrhythmias are more likely in
medication administration and health status is a patients who have preexisting cardiac disease and in
legal requirement that nurses must rigorously cases of chronic overdose.
uphold. Respecting patient rights, including the
right to refuse treatment or medication, is crucial. Cardiac Glycoside
Furthermore, adherence to laws governing the - **Mechanism of Action:**
dispensing, storage, and administration of - Cardiac glycosides, such as Digoxin, function by
controlled substances is essential in medication inhibiting the sodium-potassium pump in
practices, ensuring compliance with legal statutes. myocardial cells. This inhibition increases
intracellular calcium, leading to enhanced
In essence, the integration of regulatory and legal myocardial contractility.
considerations in medication administration forms
the ethical compass guiding nursing practice, - **Dosages and Administration:**
safeguarding patient welfare and legal compliance - Typical dosage for oral administration of
in healthcare settings. Compliance with these Digoxin is 0.125-0.25 mg daily. Dosage
standards not only ensures patient safety but also adjustments are often based on patient
fortifies the legal integrity of nursing care. characteristics and levels of cardiac function.

- **Nursing Responsibilities:**
Classification of Drugs - Nurses are responsible for monitoring the
patient’s cardiac status, particularly heart rate, as
A. Cardiovascular Agents cardiac glycosides can lead to arrhythmias.
1. Drugs Affecting the Heart Additionally, they need to monitor serum digoxin
1.1. **Cardiotonics agents** levels, assess for signs of toxicity (nausea, visual
a. **Cardiac Glycosides** disturbances), and educate patients about the
b. **Phosphodiesterase Inhibitors** importance of compliance and reporting any
adverse effects.
Cardiotonics agents
Mechanism of action: Side effects: Feeling dizzy, Nausea, Vomiting
- Cardiotonic agents, such as digoxin, work by
increasing the force and efficiency of the heart's
contractions.
 - **Nursing Responsibilities:**
B. **Phosphodiesterase Inhibitors** - Nurses must monitor the patient's blood pressure
- **Mechanism of Action:** and any symptoms of hypotension following nitrate
- Phosphodiesterase inhibitors, like Milrinone, administration. They should educate patients on the
work by inhibiting phosphodiesterase enzyme, use of nitrates, including the proper storage and
increasing intracellular cyclic adenosine administration to ensure its efficacy during angina
monophosphate (cAMP) levels, leading to positive episodes.
inotropic effects and vasodilation.
Side effects: The most common side effects of
- **Dosages and Administration:** nitrates include headaches, dizziness or light-
- Milrinone is often administered via intravenous headedness, flushing or a warm feeling in the face.
infusion, with loading doses of 50mcg/kg over 10
minutes, followed by a continuous infusion. b. **Beta-Adrenergic Blockers**
- **Mechanism of Action:**
**Nursing Responsibilities:** - Beta-blockers reduce heart rate and myocardial
- Nurses need to closely monitor the patient's contractility, thereby decreasing the heart's oxygen
hemodynamic status, including blood pressure and demand.
heart rhythm. They also need to watch for adverse
effects like hypotension and arrhythmias, ensuring - **Dosages and Administration:**
continuous assessment and close titration of the - For example, Metoprolol is administered orally
medication. in doses of 25-100 mg, one to three times daily.

Side effects: The main reported side effects of - **Nursing Responsibilities:**

PDE5i are headaches, dizziness, blushing, nasal - Nurses should monitor blood pressure and heart
congestion, dyspepsia, and visual changes. The rate, educate patients about potential side effects
most common visual side effects are photophobia, like bradycardia or dizziness, and emphasize the
cyanopsia, and haze. importance of compliance even if symptoms
subside.
1.2. **Antianginal agents**
**Nitrates, Beta-Adrenergic Blockers, Calcium Side effects: The most common side effects of
Channel Blockers** nitrates include headaches, dizziness or light-
headedness, flushing or a warm feeling in the face.
a. **Nitrates**
- **Mechanism of Action:** c. **Calcium Channel Blockers**
- Nitrates work by dilating blood vessels, - **Mechanism of Action:**
improving blood flow to the heart muscle. They - Calcium channel blockers prevent calcium from
predominantly reduce the heart's workload and entering the muscle cells of the heart and blood
oxygen demand by relaxing smooth muscle in vessels, leading to reduced blood pressure and
blood vessels. improved blood flow.

- **Dosages and Administration:** - **Dosages and Administration:**

- For instance, Isosorbide dinitrate is often - Amlodipine, for instance, is typically given
administered sublingually at doses of 5-20 mg as orally at doses of 5-10 mg once daily.
needed for chest pain. Dosage forms may also
include oral tablets or sprays.
- **Nursing Responsibilities:** - **Dosages and Administration:**
- Nurses need to monitor blood pressure and heart - Amiodarone dosage: 200-400 mg orally daily.
rate, as well as potential adverse effects like edema
or headaches. Patient education should include - **Nursing Responsibilities:**
information on adherence, especially regarding - Monitor for arrhythmia resolution and potential
potential side effects. adverse effects like pulmonary toxicity or thyroid
This breakdown offers insight into different abnormalities.
antianginal agents, their modes of action, dosage
specifications, and the associated nursing Side effects: Constipation.
responsibilities. Dizziness.
Excessive thirst.
Side effects: Key takeaways: Calcium channel Skin changes (for example, red or dry skin).
blockers (CCBs) are medications that treat high Headache.
blood pressure and other heart-related health Nausea.
conditions. Common CCB side effects include Ringing in the ears (tinnitus).
constipation, swelling in the arms and legs, and a Sensitivity to the sun.
slow heart rate. Fatigue, flushing, and dizziness can
also occur. iv. **Class IV Antiarrhythmia (Calcium
Channel Blockers)**
**Class II Antiarrhythmia (Beta-Blockers)** - **Mechanism of Action:**
- **Mechanism of Action:** - Calcium channel blockers, such as Diltiazem,
- Beta-blockers, like Metoprolol, reduce decrease calcium influx in cardiac cells, slowing
sympathetic activity on the heart, slowing heart rate heart rate and reducing contractility.
and conduction.
- **Dosages and Administration:**
- **Dosages and Administration:** - Diltiazem dosage: 30-60 mg orally every 6-8
- Metoprolol dosage: 25-100 mg orally once to hours.
twice daily.
- **Nursing Responsibilities:**
- **Nursing Responsibilities:** - Monitor blood pressure, heart rate, and any signs
- Monitor blood pressure and heart rate, educate of heart failure, edema, or dizziness.
patients about potential side effects, especially if
symptomatic bradycardia occurs. Side effects: Constipation.
Dizziness.
Side effects: Constipation. Excessive thirst.
Dizziness. Skin changes (for example, red or dry skin).
Excessive thirst. Headache.
Skin changes (for example, red or dry skin). Nausea.
Headache. Ringing in the ears (tinnitus).
Nausea. Sensitivity to the sun.
Ringing in the ears (tinnitus).
Sensitivity to the sun. 3. **Drugs Affecting the Blood Vessels**
2.1. **Antihypertensives agents (e.g.,
**Class III Antiarrhythmia** Angiotensin-Converting Enzyme Inhibitors - ACE
- **Mechanism of Action:** Inhibitors)**
- Class III agents, e.g., Amiodarone, prolong
action potentials, delaying repolarization.
 Side effects: Common side effects include
dizziness, fatigue, and cough. It is important to
- **Mechanism of Action:** monitor for signs of angioedema or hyperkalemia.
- ACE inhibitors like Enalapril inhibit the Nursing responsibilities: Nurses should monitor
conversion of angiotensin I to angiotensin II, blood pressure, renal function, and electrolyte
leading to vasodilation and reduced aldosterone levels. They should also educate patients about
secretion. lifestyle modifications and potential drug
interactions.
- **Dosages and Administration:**
- Enalapril dosage: 2.5-40 mg orally once or twice c. Calcium channel Blockers
daily. Mechanism of action: Calcium channel blockers,
such as amlodipine, prevent calcium from entering
- **Nursing Responsibilities:** the smooth muscle cells of blood vessels, resulting
- Monitor blood pressure, renal function, and signs in relaxation and lower blood pressure.
of hypotension or hyperkalemia. Uses: These agents are used to treat hypertension,
angina, and certain arrhythmias.
Side effects: Nausea, constipation, palpitation, Side effects: Common side effects include flushing,
swollen feet or legs, cold hands or feet, cramps, headache, and dizziness. Nurses should monitor for
persistent dry cough, skin rash, frequent urination, signs of hypotension or bradycardia.
and decreased sexual desires. Nursing responsibilities: Nurses should monitor
blood pressure, heart rate, and potential drug
Angiotensin-Converting Enzyme (ACE interactions. They should educate patients about the
Inhibitors) importance of compliance with medication and
Mechanism of action: ACE inhibitors, such as potential side effects.
lisinopril, block the action of an enzyme called
angiotensin-converting enzyme, which reduces the d. **Vasodilators**
production of angiotensin II, a hormone that causes - **Mechanism of Action:**
blood vessels to constrict. - Vasodilators work in various ways, but most
commonly they relax the smooth muscle cells in the
Uses: ACE inhibitors are used to treat hypertension, walls of blood vessels. This relaxation causes the
heart failure, and certain kidney conditions. blood vessels to widen, allowing blood to flow
Side effects: Common side effects include cough, more easily and reducing the pressure exerted on
dizziness, and hypotension. It is important to the vessel walls.
monitor for signs of angioedema or hyperkalemia.
- **Dosages and Administration:**
Nursing responsibilities: Nurses should monitor :Dosages of vasodilators can vary depending on the
blood pressure, renal function, and electrolyte specific medication and the condition being treated.
levels. They should educate patients about lifestyle They can be administered orally, as tablets or
modifications, potential drug interactions, and the capsules, or through injections. It's important to
importance of compliance with medication. follow the prescribed dosage and administration
instructions provided by the healthcare provider or
a. b.Angiotensin II. Receptor Blockers(ARBs)
pharmacist.
Mechanism of action: ARBs, like losartan, block
the action of angiotensin II, a hormone that causes
-
blood vessels to constrict, thereby reducing blood
pressure.
Uses: ARBs are used to treat hypertension, heart
failure, and diabetic nephropathy.
 c. Cholesterol absorption Inhibitor
**Nursing Responsibilities:** Mechanism of action: Cholesterol absorption
- Educating the patient: Provide comprehensive inhibitors, like ezetimibe, inhibit the absorption of
education to the patient about the medication, cholesterol from the intestines, leading to reduced
including its purpose, potential side effects, and the cholesterol levels in the bloodstream.
importance of compliance with the prescribed Uses: Cholesterol absorption inhibitors are used to
dosage and administration schedule. lower cholesterol levels, often in combination with
other antihyperlipidemic agents.
2.2 Antihypotensive agents Side effects: Common side effects include diarrhea,
Mechanism of action: Antihypotensive agents, like abdominal pain, and fatigue. Nurses should monitor
midodrine, work by constricting blood vessels and for signs of liver function abnormalities.
increasing blood pressure. Nursing responsibilities: Nurses should monitor
Uses: These agents are used to treat orthostatic lipid levels, bowel function, liver function, and
hypotension and certain cases of hypotension. potential drug interactions. They should educate
Side effects: Common side effects include patients about dietary modifications, potential side
hypertension, urinary retention, and piloerection. It effects, and proper administration.
is important to monitor for supine hypertension and
adjust dosage accordingly. 3. **Drugs Affecting Blood and Blood-Forming
Tissues**
Nursing responsibilities: Nurses should monitor
blood pressure, heart rate, and urinary output. They a. **Erythropoietin**
should educate patients about proper dosage - **Mechanism of Action:**
administration and potential side effects. - Erythropoietin stimulates red blood cell
production in the bone marrow.
2.3 Antilipmecs/ Antihyperlipidemic agents
a. Bile acid Sequestrants - **Dosages and Administration:**
- Dosage varies depending on the patient's anemia
b. HMG-COA Reductase Inhibitors severity, often administered subcutaneously or
Mechanism of action: Statins, such as atorvastatin, intravenously.
inhibit an enzyme called HMG-CoA reductase,
which plays a key role in cholesterol synthesis. By - **Nursing Responsibilities:**
reducing cholesterol production, statins help lower - Monitor hemoglobin levels, iron status, and
blood cholesterol levels. potential side effects like hypertension or
thrombotic events.
Uses: Statins are used to lower cholesterol levels
and reduce the risk of cardiovascular events, such B. Iron Preparations
as heart attacks or strokes. Mechanism of action: Iron preparations, such as
ferrous sulfate, provide supplemental iron to the
Side effects: Common side effects include muscle body, which is essential for the production of red
pain, liver function abnormalities, and blood cells and oxygen transport.
gastrointestinal symptoms. Nurses should monitor Uses: Iron preparations are used to treat iron
for signs of myopathy or rhabdomyolysis. deficiency anemia or prevent iron deficiency in
certain individuals.
Nursing responsibilities: Nurses should monitor
lipid levels, liver function, and potential drug
interactions. They should educate patients about
lifestyle modifications, potential side effects, and Side effects: Common side effects include
the importance of compliance with medication. constipation, nausea, and dark stools. Nurses should
monitor for signs of iron overload or allergic - **Mechanism of Action:**
reactions. - Heparin prevents clot formation by enhancing
Nursing responsibilities: Nurses should monitor the activity of antithrombin, reducing the
hemoglobin levels, iron stores, and potential drug conversion of fibrinogen to fibrin.
interactions. They should educate patients about
dietary modifications, proper administration, and - **Dosages and Administration:**
potential side effects. - Heparin is often administered subcutaneously or
intravenously, with dosages tailored to the patient's
c. Folic Acid Derivatives condition.
Mechanism of action: Folic acid derivatives, such
as folic acid itself, are essential for the synthesis of - **Nursing Responsibilities:**
DNA and red blood cells. They help support normal - Monitor clotting times (e.g., activated partial
cell growth and division. thromboplastin time - APTT), signs of bleeding,
Uses: Folic acid derivatives are used to treat or and educate patients about precautions to prevent
prevent folic acid deficiency, which can lead to bleeding episodes.
anemia or neural tube defects in pregnant women.
Side effects: Folic acid derivatives are generally a. Antiplatelet:
well-tolerated with minimal side effects. Nurses Nursing responsibilities: Promoting adherence to
should monitor for signs of allergic reactions or prescribed therapy, monitoring for symptoms of
interactions with certain medications. hemorrhaging, and platelet functional testing.
Nursing responsibilities: Nurses should educate Uses: It is often necessary to prevent blood clots
patients about the importance of folic acid when managing diseases e.g. heart disease and
supplementation, especially during pregnancy. stroke which include antiplatelet medications like
They should also monitor for potential drug aspirin and clopidogrel.
interactions. Side effects: The patient can experience bruises,
bleeding in gums, stomach cramps and rashes
d. Vitamin B12 among others.
Mechanism of action: Vitamin B12, also known as General action: Antiplatelets drugs prevent platelet
cobalamin, is essential for the production of red aggregation hence blocking blood clot formation.
blood cells and proper nerve function.
Uses: Vitamin B12 is used to treat or prevent b. Anticoagulant:
vitamin B12 deficiency, which can cause Nursing responsibilities: Frequent coagulation
megaloblastic anemia or neurological symptoms. tests, patient education about probable side-effects
Side effects: Vitamin B12 is generally well- and their relation to doses, and search for
tolerated with minimal side effects. Nurses should haemorrhages.
monitor for signs of allergic reactions or Uses: Warfarin and heparin anticoagulants have
interactions with certain medications. been adopted to prevent and treat blood clotting
Nursing responsibilities: Nurses should educate conditions like deep vein thrombosis and atrial
patients about the importance of vitamin B12 fibrillation.
supplementation, especially in cases of deficiency. Side effects: These side-effects may include
bleeding, bruises, and drug interaction.
General action: Anticoagulants inhibit or
counteract the effect of clotting factors on blood,
inhibiting the formation of blood clots.

c. Low-Molecular-Weight Heparins (LMWHs):

4. **Drugs Affecting Blood Coagulation** Nursing responsibilities: Giving injections,
4.1. **Anticoagulants (e.g., Heparin)** looking out for bruises/bleeds and education on self
administration where applicable. Side effects: These might produce gastrointestinal
disorders, allergies and rare thromboembolic
Uses: Enoxaparin and dalteparin are examples of incidents.
low molecular weight heparins that are commonly General action: Systemic hemostatic agents act by
employed as prophylactics for blood clotting, fostering the clotting process either by
especially during deep vein thrombosis or strengthening the clots or releasing more clotting
pulmonary embolism. factors through their storing places in the human
Side effects: These may lead to bleeding, bruising, organism.
severe pain at the injection site or even
thrombopaenia. B. Respiratory Agents
General action: The drugs are made up of 1. **Drugs Acting on the Upper Respiratory
LMWHs that inhibit some clot forming factors. Tract**
a. **Antitussives**
4.2 Drugs used to Control Bleeding - **Mechanism of Action:**
a. Antihemophilic Agents: - Antitussives like Dextromethorphan act on the
Nursing responsibilities: These include giving the cough center in the medulla, suppressing cough
medicine, looking out for the cases of bleeding and reflex.
allergies reaction if any, teaching patients on how
they can administer drugs on themselves and - **Dosages and Administration:**
working jointly with the health providers - Dextromethorphan dosage: 10-20 mg orally
concerning suitable dosage among other issues. every 4-6 hours.
Uses: There are various antihemophilic agents that
are used for treating diseases like hemophilia A and - **Nursing Responsibilities:**
B. They are used to enhance the clotting ability of - Assess the frequency and severity of cough,
blood by replacing or supplementing the monitor for adverse effects like dizziness or
insufficient clotting factor in the blood. sedation, and provide guidance on fluid intake.
Side effects: These include mild possible side
effects such as allergic reactions and rare ones such b. **Decongestants**
as the transmission of infectious agent and - **Mechanism of Action:**
developing inhibitors (antibodies against the - Decongestants, such as Phenylephrine, constrict
clotting factor). blood vessels, reducing swelling in nasal passages.
General action: Antihemophilic, antihaemophilic
agents act temporarily either by raising or - **Dosages and Administration:**
substituting a sufficient quantity of abnormal - Phenylephrine dosage: 10-20 mg orally every 4
clotting factor and thus help in correct blood hours.
stoppage and stop bleeding.
- **Nursing Responsibilities:**
B. Systemic Hemostatic Agents: - Monitor for hypertension, assess nasal
Nursing responsibilities: Giving the drug, congestion relief, and educate on proper
observing any complications that may arise, taking administration techniques.
vital signs of the patients, and teaching them about
the possible risks and advantage of the medicine.

Uses: They include systemic hemostatic agents

such as tranexamic acid and desmopressin used in C. **Antihistamines**
hemophilia, intra-operative cases and when there - **Mechanism of Action:**
are traumatic injuries with abnormal bleeding. - Antihistamines like Loratadine block histamine
receptors, reducing allergy symptoms.
 - **Dosages and Administration:**
- **Dosages and Administration:** - Theophylline dosage: 200-400 mg orally every
- Loratadine dosage: 10 mg orally once daily. 8-12 hours.

- **Nursing Responsibilities:** - **Nursing Responsibilities:**

- Monitor for drowsiness, assess allergy symptom - Monitor for bronchodilation, assess for signs of
relief, and provide guidance on potential toxicity (e.g., arrhythmias), and educate on proper
drowsiness. use and potential interactions.

d. **Expectorants** b. *Sympathomimetics*
- **Mechanism of Action:** - *Mechanism of Action:*
- Expectorants, such as Guaifenesin, increase - Sympathomimetics like Albuterol activate beta-2
respiratory tract fluid to facilitate mucus removal. adrenergic receptors, leading to bronchodilation.

- **Dosages and Administration:** - *Dosages and Administration:*

- Guaifenesin dosage: 200-400 mg orally every 4 - Albuterol dosage: 2.5-5 mg via inhalation every
hours. 4-6 hours.

- **Nursing Responsibilities:** - *Nursing Responsibilities:*

- Monitor cough and sputum production, assess for - Monitor for bronchodilation, assess for potential
any allergic reactions, and educate on adequate adverse effects like tachycardia, and educate on the
fluid intake. use of inhalers.

e. **Mucolytics** -Side effects: dry mouth, decreased alertness,

- **Mechanism of Action:** sedation, and depression.
- Mucolytics like Acetylcysteine break down
mucus disulfide bonds, reducing mucus viscosity. c. *Anticholinergics*
- *Mechanism of Action:*
- **Dosages and Administration:** - Anticholinergics like Ipratropium bromide block
- Acetylcysteine dosage: Varies depending on the cholinergic receptors, leading to bronchodilation.
route (inhaled or oral).
- *Dosages and Administration:*
- **Nursing Responsibilities:** - Ipratropium bromide dosage: 18-90 mcg via
- Monitor respiratory secretions, assess airway inhalation every 4-6 hours.
patency, and educate on administration techniques
and potential odor. - *Nursing Responsibilities:*
- Monitor for bronchodilation, assess for potential
2. **Drugs Used to Treat Obstructive side effects like dry mouth, and educate on inhaler
Pulmonary Disorders** use.
a. **Bronchodilators/Antiasthmatic,
Xanthines** Uses: The bottom line. Anticholinergic drugs block
the action of a neurotransmitter called
acetylcholine. This inhibits nerve impulses
responsible for involuntary muscle movements and
- **Mechanism of Action:** various bodily functions. These drugs can treat a
- Xanthines like Theophylline relax bronchial variety of conditions, from overactive bladder to
smooth muscles, widening airways. chronic obstructive pulmonary disorder.
Side effects: Common central anticholinergic Uses: Leukotriene modifiers, also called
adverse effects include headache, impaired leukotriene receptor antagonists, are a group of
memory, reduced cognitive function, behavioral medications. They can help prevent breathing
disturbances, anxiety, and insomnia at low dosages problems associated with allergies, asthma and
chronic obstructive pulmonary disease.
d. *Inhaled Steroids*
- *Mechanism of Action:* f. *Lung Surfactants*
- Inhaled steroids like Fluticasone reduce airway - *Mechanism of Action:*
inflammation and mucus production. - Lung surfactants like Beractant or Poractant alfa
supplement natural lung surfactant, improving lung
- *Dosages and Administration:* compliance.
- Fluticasone dosage: 88-440 mcg via inhalation
twice daily. - *Dosages and Administration:*
Side effects: These putative effects may include - Administered directly into the trachea by
adrenal suppression, bone loss, skin thinning, healthcare professionals in neonatal respiratory
increased cataract formation, decreased linear distress syndrome.
growth in children, metabolic changes, and
behavioral abnormalities. - *Nursing Responsibilities:*
Uses: Steroid inhalers, also called corticosteroid - Collaboration with healthcare providers for
inhalers, are anti-inflammatory sprays or powders administration and monitoring of neonates
that you breathe in. They're mainly used to treat receiving lung surfactants.
asthma and chronic obstructive pulmonary disease
(COPD). Steroid inhalers are only available on Side effects: Cyanosis (bluish skin coloration due
prescription. to low oxygen), Airway obstruction., Bradycardia
(slow heartbeat), Endotracheal tube reflux,
- *Nursing Responsibilities:* Endotracheal tube blockage, Oxygen desaturation,
- Monitor for improved breathing and potential Requirement for manual ventilation, Reintubation.
local side effects like oral thrush. Educate on proper Uses: Function. The main functions of surfactant
inhaler techniques. are as follows: (1) lowering surface tension at the
air–liquid interface and thus preventing alveolar
e. *Leukotriene Receptor Antagonists* collapse at end-expiration, (2) interacting with and
- *Mechanism of Action:* subsequent killing of pathogens or preventing their
- Leukotriene antagonists like Montelukast block dissemination, and (3) modulating immune
leukotriene receptors, reducing airway responses.
inflammation.
h. *Mast Cell Stabilizers*
- *Dosages and Administration:* - *Mechanism of Action:*
- Montelukast dosage: 10 mg orally once daily. - Mast cell stabilizers like Cromolyn sodium
prevent mast cell degranulation, reducing allergic
- *Nursing Responsibilities:* responses in the airways.
- Monitor for decreased respiratory symptoms and
potential side effects like mood changes or
gastrointestinal issues.
- *Dosages and Administration:*
Side effects: Common side effects are reported as - Cromolyn sodium dosage: 20 mg via inhalation
abdominal pain, headache and thirst. Often side four times daily.
effects can lessen or disappear after 2-3 weeks.
- *Nursing Responsibilities:*
 - Monitor for reduced allergic symptoms and
potential local irritation. Educate on the correct use - *Dosages and Administration:*
of inhalers. - Maalox dosage: Varies based on formulations
(liquid, chewable tablets).
Side effects: Headache.
Unpleasant taste.
Hoarseness. - *Nursing Responsibilities:*
Nose bleeding. - Monitor for symptom relief and potential side
Temporary nasal stinging and sneezing after effects like constipation or diarrhea. Educate on
administration. proper dosing and administration.
Uses: Mast cell stabilizing drugs inhibit the release
of allergic mediators from mast cells and are used Side effects: diarrhea or constipation., flatulence
clinically to prevent allergic reactions to common (wind), stomach cramps, feeling sick or vomiting.
allergens. Uses: Antacids help to treat heartburn (indigestion).
They work by neutralizing the stomach acid that
C. Gastrointestinal Agents causes heartburn. You can buy many antacids
1. **Drugs Affecting Gastrointestinal Secretions** without a prescription. Liquid forms work faster,
but you may prefer tablets because they are easy to
a. **Histamine-2 Antagonists** use.
- **Mechanism of Action:**
- H2 blockers like Ranitidine reduce gastric acid c. *Proton Pump Inhibitors (PPIs)*
secretion by antagonizing histamine at H2 receptors
in the stomach. - *Mechanism of Action:*
- PPIs like Omeprazole inhibit the proton pump in
- **Dosages and Administration:** gastric parietal cells, reducing acid secretion.
- Ranitidine dosage: 150 mg orally twice daily.
- *Dosages and Administration:*
- **Nursing Responsibilities:** - Omeprazole dosage: 20-40 mg orally once daily.
- Monitor for relief of gastric symptoms, assess for
potential adverse effects, and educate on proper - *Nursing Responsibilities:*
administration. - Monitor for reduced symptoms, assess for
potential adverse effects like increased risk of
Side effects: Side effects are uncommon, usually fractures or C. difficile infection.
minor and include diarrhea, constipation, fatigue,
drowsiness, headache and muscle aches. The H2 Side effects: In general, PPIs are believed to have
receptor blockers are metabolized in the liver by the few adverse effects, as they are generally well
cytochrome. tolerated. Patients have experienced few minor side
Uses: The selective histamine type 2 receptor effects of short-term PPI use, such as headache,
antagonists/blockers (H2 blockers) are widely used rash, dizziness, and gastrointestinal symptoms
in the treatment of acid-peptic disease, including including nausea, abdominal pain, flatulence,
duodenal and gastric ulcers, gastroesophageal constipation, and diarrhea.
reflux disease and common heartburn. Uses: Proton pump inhibitors are used to: Relieve
symptoms of acid reflux, or gastroesophageal reflux
B. *Antacids* disease (GERD). This is a condition in which food
- *Mechanism of Action:* or liquid moves up from the stomach to the
- Antacids like Maalox or Tums neutralize gastric esophagus (the tube from the mouth to the
acid, providing short-term relief from heartburn or stomach). Treat a duodenal or stomach (gastric)
indigestion. ulcer.
 - *Dosages and Administration:*
d. *Antipeptic Agent* - Pancrelipase dosage: Based on individual patient
- *Mechanism of Action:* need, taken with meals.
- Antipeptic agents like Sucralfate coat ulcers or
damaged mucosa, providing a protective barrier - *Nursing Responsibilities:*
against gastric acid. - Monitor for improved digestion and potential
side effects like abdominal pain. Educate on proper
- *Dosages and Administration:* timing and dosage.
- Sucralfate dosage: 1 g orally four times daily.
Side effects: Head ache, Neck pain, Gas, stomach
- *Nursing Responsibilities:* pain, Diarrhea, Asthma
- Monitor for ulcer healing and potential adverse
effects like constipation. Educate on administration Uses: Digestive enzymes play a key role in
guidelines. breaking down the food you eat. These proteins
speed up chemical reactions that turn nutrients into
e. *Prostaglandin* substances that your digestive tract can absorb.
- *Mechanism of Action:* Your saliva has digestive enzymes in it. Some of
- Prostaglandins like Misoprostol reduce gastric your organs, including your pancreas, gallbladder,
acid secretion and protect the stomach lining. and liver, also release them.

- *Dosages and Administration:* 2.1 Laxatives:

- Misoprostol dosage: 200 mcg orally four times a. Chemical Stimulants:
daily. Nursing responsibilities: Performing the drug as
prescribed, analyzing if there are complications,
- *Nursing Responsibilities:* teaching the patient how to use it well and the
- Monitor for symptom improvement and potential possible consequences.
adverse effects like diarrhea. Educate on medication Uses: The chemical stimulators that include
use and precautions. bisacodyl and senna can be taken to stimulate colon
contractions and improve bowel movement leading
Side effects: nausea, vomiting, flushing, fever, to a decrease in pain associated with constipation.
back pain, diarrhea, and abdominal pain. Side effects: Short term usage may lead to lower
Uses: Prostaglandins act as signals to control back pain, heart problems, abdomen cramping,
several different processes depending on the part of electrolyte imbalance, thirst, constipation and
the body in which they are made. Prostaglandins are dehydration while chronic misuse may result in
made at sites of tissue damage or infection, where dependency.
they cause inflammation, pain and fever as part of General action: In this category of the chemical
the healing process. stimulants, they are referred to as the stimulant
laxatives or the direct stimulants.

B. Bulk Laxatives:
F. *Digestive Enzymes* Nursing responsibilities: Ensuring sufficient fluid
- *Mechanism of Action:* intake during administration, monitoring bowel
- Digestive enzymes like Pancrelipase aid in function and stool consistency, evaluating for
digestion by replacing enzymes lacking in potential side effects, and instructing patients on
conditions such as pancreatic insufficiency. maintaining adequate hydration.
Uses: Various kinds of bulk laxative are used for
treatment of constipation such as psyllium or 2.3 Antidiarrheal Drugs:
methylcellulose that adds more content in stool and Nursing responsibilities: The nurse should
makes easy flow of the bowel movement. administer the medication as directed; monitor for
Side effects: Such symptoms as indigestion, gastric any adverse effects or drug-drug interactions; and
pains, and a narrowed throat are expected. They can assess bowel movements and stool consistency,
be experienced when taking these drugs without provide health education regarding appropriate use
proper amounts of fluid to avoid such scenarios. of the medication and common side effects.
General action: The mechanism of action for bulk Uses: The purpose of antidiarrheal drugs like
laxatives involves absorption of water within the loperamide or bismuth subsalicylate is to reduce
intestinal tract so as to increase stool bulk, make it intestinal motility and also fluid secretion to limit
softer, and then stimulate bowel movement. the severity of diarrhea.
Side effects: These can include constipation,
c. Lubricants: stomach ache, sleepiness or dryness in the mouth.
Nursing responsibilities: Giving the drug General action: These antidiarrheal drugs decrease
according to instructions, checking for bowel the number and liquidness of bowel movements, so
movements and stool consistency, observing of that the bowels can absorb more water from feces.
possible adverse effects and telling patients about
correct dosage and possible unwanted reactions. 3. Emetic and Antiemetic Agents:
Uses: These laxative lubricants like mineral oil and Emetic Agents:
the glycerin suppressors help alleviate constipation Nursing responsibilities: Providing emetics at
by coating with the stool on its way down and the suitable points, observing the patients following the
inner walls of intestines. administration and supportive care while throwing
Side effects: These could be leakage, itching is taking place.
around the anuses, as well as the interference when Uses: In acute poisoning and drug overdose, emetic
one tries to absorb fat soluble vitamins. agents like ipecac syrup or apomorphine make
General action: Laxative lubricants serve to lube patients vomit.
both the stools and the intestinal wall so as to ease Side effects: These can also have side effects,
passage of the solid wastes. which are likely to be aspiration, dehydration, or
irritation of the gastrointestinal tract.
2.2 Gastrointestinal Stimulants: General action: Vomiting occurs in response to
Nursing responsibilities: Dispensing the drug emetic agents. The latter in turn stimulate the
according to prescription, observing for any signs chemoreceptor trigger zones in the brain and induce
of negative effects or interplay, checking bowels, this reflex in an effort to push out any toxic
and teaching patients about right use and risks contaminants contained in gastrointestinal fluids.
associated with this medicine.
Uses: Metoclopramide or domperidone Antiemetic Agents:
gastrointestinal stimulants increase gastrointestinal Nursing responsibilities: Giving the antiemetic
motility and alleviate symptoms such as nausea, drugs as required, observing for any potential
bloating and delayed gastreointinal emptying. unwanted reactions/interactions, evaluating how
Side effects: These may involve drowsiness, well symptoms are controlled, and offering comfort
restlessness, extrapyramidal symptoms (certain to people who have nausea and vomiting.
drugs) or gastrointestinal disorders. Uses: Ondansetron or metoclopramide are the
General action: Gastrointestinal stimulants are antiemetic agents used for preventing and relieving
agents that strengthen the muscular contractile nausea and vomiting in such conditions like
activities and motility in the gut-walls thereby chemotherapy, surgical recovery, motion sickness,
promoting good passage of food and waste material etc.
through gut lumen.
Side effects: Some of these are drowsiness, - **Dosages and Administration:**
dizziness, extrapyramidal symptoms with some - Amoxicillin dosage: 500 mg orally every 8
drugs, and gastrointestinal problems. hours.
General Action: Antiemetic agents work in
different ways to prevent or alleviate nausea and - **Nursing Responsibilities:**
vomiting. Some medications target specific - Monitor for resolution of bacterial infection,
receptors in the brain, such as dopamine or assess for allergic reactions, and educate on
serotonin receptors, to reduce the signals triggering completing the full course of antibiotics.
nausea. Others may act on the gastrointestinal
system, helping to regulate the movement of food Side effects: Penicillin V and G can have adverse
and fluids and preventing the urge to vomit. effects, including nausea, vomiting, diarrhea, rash,
abdominal pain, and urticaria. In addition, Penicillin
D. Antipyretic / Anti-inflammatory / Analgesic G can have other adverse reactions, including
Agents muscle spasms, fever, chills, muscle pain,
1. **Non-Steroidal Anti-Inflammatory Drugs headache, tachycardia, flushing, tachypnea, and
(NSAIDs)** hypotension.
- **Mechanism of Action:** Uses: Penicillins are used to treat infections caused
- NSAIDs like Ibuprofen inhibit cyclooxygenase by bacteria. They work by killing the bacteria or
enzymes, reducing prostaglandin production, preventing their growth. There are several different
thereby providing pain relief and reducing kinds of penicillins. Each is used to treat different
inflammation. kinds of infections.

- **Dosages and Administration:** F. Neurologic and Neuromuscular Agents

- Ibuprofen dosage: 200-400 mg orally every 4-6 1. Drugs Affecting the Central Nervous System
hours. 1.1 Anxiolytic And Hypnotic Agents
a. Benzodiazepines
- **Nursing Responsibilities:** b. Barbiturates
- Monitor for pain relief, assess for potential
gastrointestinal side effects, and educate on taking 1.2 Antidepressants agents
NSAIDs with food. a. Tricyclic Antidepressants
b. Monoamine Oxidase Inhibitors (MAO)
Side effects: indigestion – including stomach aches, c. Selective Serotonin Reuptake Inhibitors
feeling sick and diarrhoea. (SSRI)
stomach ulcers – these can cause internal bleeding d. Other Antidepressants
and anaemia; extra medicine to protect your
stomach may be prescribed to help reduce this risk. 1.3 Psychotherapeutic Agents
Uses: Non-steroidal anti-inflammatory drugs a. Antipsychotic / Neuroleptic Drugs
(NSAIDs) are commonly used to manage the pain b. Antimanic Drugs
and inflammation (swelling and redness) associated c. CNS Stimulants
with some types of arthritis (such as rheumatoid
arthritis) and other musculoskeletal disorders. 1.4 Antiepileptic Agents
1.5 Antiparkinsonism Agents*
E. Antibacterials / Antibiotics 1.6 Muscle Relaxants*
1. **Penicillins** 1.7 Narcotics and Antimigraine Agents
- **Mechanism of Action:** 1.8 General and Local Anesthetic Agents*
- Penicillins like Amoxicillin inhibit bacterial cell 1.9 Neuromuscular Junction Blocking Agents*
wall synthesis, leading to bacterial cell lysis. 2. Drugs Affecting Autonomic Nervous System
2.1 Adrenergics / Adrenergic Blockers
2.2 Cholinergic / Anticholinergic
G. Antineoplastic Agents References
1. Alkylating agents
2. Antimetabolites Books:
3. Antineoplastic Antibiotics
4. Mitotic Inhibitors 1. **"Davis's Drug Guide for Nurses"** by April
5. Hormones and Hormone Modulators Vallerand and Cynthia Sanoski
6. Protein Tyrosine Kinase Inhibitors 2. **"Pharmacology and the Nursing Process"** by
7. Antineoplastic Adjunctive Therapy Linda Lane Lilley, Shelly Rainforth Collins, and
Julie S. Snyder
H. Endocrine Agents 3. **"Pharmacotherapeutics for Advanced
1. Hypothalamic and Pituitary Agents Practice"** by Tammie Lee Demler
1.1 Hypothalamic Releasing Hormones 4. **"Clinical Pharmacology Made Incredibly
1.2 Anterior Pituitary Hormones Easy"** by Lippincott Williams & Wilkins
1.3 Growth Hormone Antagonists 5. **"Handbook on Injectable Drugs"** by
1.4 Posterior Pituitary Hormones Lawrence A. Trissel
2. Adrenocortical Agents
2.1 Glucocorticoids Databases and Online Resources:
2.2 Mineralo-corticoids
3. Thyroid and Parathyroid Agents 1. **Micromedex**
3.1 Thyroid Hormones 2. **Lexicomp**
3.2 Antithyroid Agents 3. **Medscape**
3.3 Antihypocalcemic Agents 4. **UpToDate**
3.4 Antihypercalcemic Agents 5. **PubMed**
4. Antidiabetic Agents
4.1 Insulin Guidelines and Professional Organizations:
4.2 Oral Antidiabetic Agents
4.3 Glucose Elevating Agents 1. **FDA (U.S. Food and Drug Administration)**
I. Reproductive and Gender related Agents 2. **CDC (Centers for Disease Control and
1. Drugs Related to women’s health and disorder Prevention)**
1.1 Contraceptives 3. **WHO (World Health Organization)**
1.2 Fertility / Infertility Drugs 4. **Institutional Hospital Formularies and
1.3 Drugs used to treat Uterine Dysfunction Guidelines**
1.4 Abortifacients Drug Interactions, Contraindications, and Adverse
2. Drugs Affecting the Male Reproductive Effects:
System
2.1 Androgens 1. **Drug Interactions:**
2.2 Anabolic Steroids - Detail potential interactions between drugs,
2.3 Drugs for Treating Penile Erectile describing how one drug may affect the efficacy or
Dysfunction safety of another. Include information about drug-
3. Drugs for STD drug, drug-food, and drug-supplement interactions.

J. Drugs Affecting Fluid and Electrolyte Balance 2. **Contraindications:**

- Highlight specific scenarios or conditions in
K. Nutritional Supplements which the use of a particular drug is not
recommended due to potential risks or adverse
L. Immunizing Agents effects.
3. **Adverse Effects:**
- Enumerate potential side effects associated with
each medication or drug class, emphasizing
common and severe adverse effects. This includes
physical, psychological, and allergic reactions.

Nursing Implications for Special Populations:

1. **Pediatric Considerations:**
- Describe adjustments in dosages, formulations,
and potential side effects for pediatric patients.
Emphasize safety measures and considerations
specific to children.

2. **Geriatric Considerations:**
- Explain changes in drug metabolism, potential
complications due to multiple medications
(polypharmacy), and considerations for reducing
adverse effects in the elderly population.

3. **Pregnancy and Lactation:**

- Detail the potential risks or benefits of drug use
during pregnancy and lactation, including potential
effects on the fetus and breastfeeding
considerations. Emphasize safety protocols and
medications to avoid.

4. **Patients with Comorbidities:**

- Discuss special considerations for patients with
chronic diseases (e.g., diabetes, renal or hepatic
impairment), outlining medication adjustments and
potential risks.

5. **Cultural and Ethnic Considerations:**

- Include information on how cultural beliefs or
ethnic background may influence medication
adherence, response to treatment, or perceptions of
healthcare.

Including these considerations in the portfolio

enhances the depth and breadth of information
provided to nurses for safe and effective medication
administration across diverse patient populations
and circumstances. It's crucial to stay updated on
the latest research and guidelines to provide the
most accurate and comprehensive information for
nursing practice.