PHARMACOLOGY FOR NURSING STUDENTS

ACTIVITY NO. 1
BASIC PRESCRIPTION READING AND WRITING

I. Objective/Outcome

As future nurse practitioner, the student must be knowledgeable of the basic

principles of prescription. The student is expected to:

 Perform reading/interpretation and write medication orders.

 Demonstrate an understanding of the format and components of a typical
prescription.
 Demonstrate an understanding of the format and components of a typical
institutional medication order.
 Interpret correctly standard abbreviations and symbols used on prescriptions and
medication orders.
 Differentiate between patient compliance and noncompliance and apply
calculations to determine compliancy.

II. Discussion

By definition, a prescription is an order for medication issued by a physician,

dentist, or other properly licensed medical practitioner. A prescription designates a
specific medication and dosage to be prepared by a pharmacist and administered to
a particular patient.

A prescription is usually written on preprinted forms containing the traditional

symbol Rx (meaning ‘‘recipe,’’ ‘‘take thou,’’ or ‘‘you take’’), name, address,
telephone number, and other pertinent information regarding the physician or other
prescriber. In addition, blank spaces are used by the prescriber to provide information
about the patient, the medication desired, and the directions for use. A prescription
written by a veterinarian generally includes the animal species and/ or pet’s name
and the name of the owner.

A written prescription may be presented at the pharmacy by the patient or

caregiver, or it may be transmitted from the prescriber by telephone or by other
electronic means. In the latter instances, the pharmacist immediately reduces the
order to a properly written form or computer entry.
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In hospitals and other institutions, the forms are somewhat different and are
referred to as medication orders. The orders shown in this example are typed;
typically, these instructions are written by the physician in ink.

A. USE OF ABBREVIATIONS AND SYMBOLS

The use of abbreviations is common on prescriptions and medication orders. Some

are derived from the Latin through its historical use in medicine and pharmacy,
whereas others have evolved through prescribers’ use of writing shortcuts.
Unfortunately, medication errors can result from the misuse, misinterpretation, and
illegible writing of abbreviations, and through the use of ad hoc, or made-up,
abbreviations. The use of a controlled vocabulary, a reduction in the use of
abbreviations, care in the writing of decimal points, and the proper use of leading and
terminal zeros have been urged to help reduce medication errors. It should be
emphasized that a misplaced or misread decimal point represents a minimum of a
10-fold error. Among the specific recommendations to help reduce medication errors
arising from poorly written, illegible, or misinterpreted prescriptions and medication
orders are the following:

 A whole number should be shown without a decimal point and without a

terminal zero (e.g., express 4 milligrams as 4 mg and not as 4.0 mg).
 A quantity smaller than one should be shown with a zero preceding the decimal
point (e.g., express two tenths of a milligram as 0.2 mg and not as 0.2 mg).
 Leave a space between a number and the unit (e.g., 10 mg and not 10 mg).
 Use whole numbers when possible and not equivalent decimal fractions (e.g.,
use 100 mg and not 0.1 g).
 Use the full names of drugs and not abbreviations (e.g., use phenobarbital and
not PB).
 Use USP designations for units of measure (e.g., for grams, use g and not Gm
or gms; for milligrams, use mg and not mgs or mgm).
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 Spell out ‘‘units’’ (e.g., use 100 units and not 100 u or 100 U since an illegible
U may be misread as a zero, resulting in a 10-fold error, i.e., 1000). The
abbreviation I.U., which stands for ‘‘Interna- tional Units,’’ should also be
spelled out so it is not interpreted as I.V., meaning ‘‘intravenous.’’
 Certain abbreviations that could be mistaken for other abbreviations should be
written out (e.g., write ‘‘right eye’’ or ‘‘left eye’’ rather than use o.d. or o.l., and
spell out ‘‘right ear’’ and ‘‘left ear’’ rather than use a.d. or a.l.).
 Spell out ‘‘every day’’ rather than use q.d.; ‘‘every other day,’’ rather than q.o.d;
and ‘‘four times a day,’’ rather than q.i.d to avoid misinterpretation.
 Avoid using d for ‘‘day’’ or ‘‘dose’’ because of the profound difference between
terms, as in mg/kg/ day versus mg/kg/dose.
 Integrate capital or ‘‘tall man’’ letters to distinguish between ‘‘look alike’’ drug
names, such as AggreSTAT and AggreNOX; hydrOXYZINE and
hydrALAZINE; and DIGoxin and DESoxyn.
 Amplify the prescriber’s directions on the prescription label when needed for
clarity (e.g., use ‘‘Swallow one (1 ) capsule with water in the morning’’ rather
than ‘‘one cap in a.m.’’).
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PHARMACOLOGY FOR NURSING STUDENTS

III. Interpret the following orders.

A. Interpret each of the following Subscriptions (directions to the pharmacist)

taken from prescriptions:
 Disp. supp. rect. no. xii - Dispence 12 pcs of rectal suppositories
 M. ft. iso. sol. Disp. 120 mL. - mix and make isotonic solution and dispence in
120 mL
 M. et div. in pulv. no. xl - mix and divide to powder in 40
 DTD vi. Non rep. - give 6 doses and do not repeat
 M. et ft. ung. Disp. 10 g - mix and make ointment and dispence in 10g
 M. et ft. caps. DTD xlviii - mix and make 48 doses in capsule
 M. et ft. susp. 1 g/tbsp. Disp. 60 mL. - mix and make 1gram/tablespoon
suspense and dispense 60 mL
 Ft. cap. #1. DTD no.xxxvi N.R. - make 1 capsule and give in 37 doses and do
not repeat
 M. et ft. pulv. DTD #C - mix and make 100 doses in powdered form
 M. et ft. I.V. inj. - mix and make then inject intravenously
 Label: hydrocortisone, 20 mg tabs.- label: 20 miligrams of tablets of
hydrocortisone

B. Interpret each of the following Signas (directions to the patient) taken from
prescriptions:
 Gtt. ii each eye q. 4 h. p.r.n. pain. - two drops in each eye every 4 hours as
needed in pain

 Tbsp. ii n1⁄3 gl.aq.q.6h. - take 2 tablespoon in the night and 1/3 glass of water
every 6 hours
 Appl. a.m. & p.m. for pain prn. - apply every morning and afternoon as
needed in pain
 Gtt. iv right ear m. & n. - four drops in right ear at morning and night
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 Tsp.i ex aq. q.4 or 5h. p.r.n. pain. - take 1 tablespoon in water every 4 or 5
hours as needed in pain
 Appl. ung. left eye ad lib. - apply ointment in left eye freely
 Caps i c ̄ aq. h.s. N.R. - take 1 capsule with water at bedtime and do not
repeat
 Gtt. v each ear 3 d. s.o.s. - 5 drops in each ear for 3 days if there is a need
 Tab. i sublingually, rep. p.r.n. - take 1 tablet subligually and repeat as needed
 Instill gtt. ii each eye of neonate. - instill 2 drops in each eye of neonate
 Dil. c ̄ = vol. aq. and use as gargle q. 5h - dilute with equal volume of water
and use as gargle every 5 hours
 Cap. ii 1 h. prior to departure, then - take 2 capsules one hour prior to
departure
 cap. i after 12 h.- take 1 capsule after 12 hours
 Tab i p.r.n. SOB- take 1 tablet as neded in shortness of breath
 Tab i qAM HBP - take 1 tablet every morning for high blood pressure
 Tab ii q 6h ATC UTI - take 2 tabs every 6 hours for urinary tract infection
around the clock
 Add crushed tablet to pet’s food s.i.d. - add crushed tablet too pets food once
a day

C. Interpret each of the following taken from medication orders:

 AMBIEN 10mg p.o. q hs 5d - take 10 mg of ambien per orem every bedtime

for 5 days
 1000mL D5W q.8h. IV c ̄ 20 mEq KCl to every third bottle. - administer 100ml
dextrose intravenously every 8 hours with 20 milliequivalent potassium
chloride to every third bottle
 Admin. Prochlorperazine 10 mg IM q. 3h. prn N&V - administer 10 mg of
prochlorperazine intramuscular every 3 hours as needed in nausea and
vomiting
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 Minocycline HCl susp. 1 tsp p.o. q.i.d. DC after 5 d. - suspence 1 tablespoon of

minocycline hydrochloric per orem for 4 times a day and will be
discontinued after 5 days
 Propranolol HCl 10 mg p.o. t.i.d. a.c. & h.s. - take 10mg of propanol
hydrochloric per orem for three times a day before meals and at bedtime
 NPH U-100 insulin 40 Units subc every day A.M. - administer 40 units of NPH
U-100 subcutaneously every day in morning
 Cefamandole nafate 250mg IM q.12 h. - take 250mg of cefamandole nafate
intramuscular every 12 hours
 Potassium chloride 15 mEq p.o. b.i.d. p.c. - administer 15 milliequivalent of
potassium chloride per orem twice a day aftermeals

 Vincristine sulfate 1 mg/m2 pt. BSA. - pint of 1mg/m2 of vincristine sulfate in

the body surface area
 Flurazepam 30 mg at HS prn sleep. - take 30 mg of flurazepam at bedtime as
needed to sleep
 2.5 g/kg/day amino acids TPN. - administer 2-5 grams/ kilograms/ day of
amino acids in total parental
 PROCRIT (epoetin alpha) stat. 150 units/kg subQ. 3xwk. For 3–4 wks. -
administer 150 units/ kilogram of procrit (epoetin alpha) immediately in
subcutaneous in 3 times a week for 3 to 4 weeks
 If a10-mL vial of insulin contains 100 units of insulin per milliliter, and a patient is
to administer 20 units daily, how many days will the product last the patient?
 If the patient returned to the pharmacy in exactly 7 weeks for another vial of
insulin, was the patient compliant as indicated by the percent compliance rate?
 A prescription is to be taken as follows: 1 tablet q.i.d. the first day; 1 tablet t.i.d.
the second day; 1 tablet b.i.d. for 5 d; and 1 tablet q.d. thereafter. How many
tablets should be dispensed to equal a 30-day supply?
PHARMACOLOGY FOR NURSING STUDENTS

ACTIVITY NO. 2
BASIC COMPUTATION OF DOSES
PHARMACOLOGY FOR NURSING STUDENTS

I. Objective/Outcome

Upon successful completion of this chapter, the student will be able to:

 Differentiate between the various kinds of doses.

 Describe the primary routes of drug/dose, administration and, for each, the
dosage forms utilized.
 Perform calculations of doses involving household measures.
 Perform calculations pertaining to the quantity of a dose, the dosage regimen,
and the supply of medication required for the prescribed period.

II. Discussion

The dose of a drug is the quantitative amount administered or taken by a patient for
the intended medicinal effect. The dose may be expressed as a single dose, the amount
taken at one time; a daily dose; or a total dose, the amount taken during the course of
therapy. A daily dose may be subdivided and taken in divided doses, two or more times
per day depending on the character- istics of the drug and the illness. The schedule of
dosing (e.g., four times per day for 10 days) is referred to as the dosage regimen.

The usual adult dose of a drug is the amount that ordinarily produces the medicinal
effect intended in the adult patient. The usual pediatric dose is similarly defined for the
infant or child patient. The ‘‘usual’’ adult and pediatric doses of a drug serve as a guide
to physicians who may select to prescribe that dose initially or vary it depending on the
assessed requirements of the particular patient. The usual dosage range for a drug
indicates the quantitative range or amounts of the drug that may be prescribed within the
guidelines of usual medical practice. Drug use and dose information is provided in the
package labeling and inserts that accompany manufacturers’ pharmaceutical products,
as well as in a variety of references, such as Drug Facts and Comparisons,1 Physicians’
Desk Reference,2 Pediatric Dosage Handbook,3 Geriatric Dosage Handbook,4 and Drug
Information Handbook.5

For certain conditions, as in the treatment of cancer patients, drug dosing is highly
specialized and individualized. Frequently, combinations of drugs are used, with the
doses of each adjusted according to the patient’s response. Many anticancer drugs are
PHARMACOLOGY FOR NURSING STUDENTS

administered cyclically, usually for 21 to 28 days, with a rest period between dosing cycles
to allow recovery from the toxic effects of the drugs. As presented in Chapter 8, anticancer
drugs are most commonly dosed on the basis of the patient’s body surface area.

The median effective dose of a drug is the amount that produces the desired intensity
of effect in 50% of the individuals tested. The median toxic dose of a drug is the amount
that produces toxic effects in 50% of the individuals tested. Drugs intended to produce
systemic effects must be absorbed or placed directly into the circulation and distributed
in adequate concentrations to the body’s cellular sites of action. For certain drugs, a
correlation exists between drug dosage, the drug’s blood serum concentration after
administration, and the presentation and degree of drug effects. An average blood serum
concentration of a drug can be measured,and the minimum concentration determined that
can be expected to produce the drug’s desired effects in a patient. This concentration is
referred to as the minimum effective concentration

The base level of blood serum concentration that produces dose-related toxic effects
is referred to as the minimum toxic concentration (MTC) of the drug.

Optimally, appropriate drug dosage should result in blood serum drug concentrations
that are above the MEC and below the MTC for the period of time that drug effects are
desired. As shown in Figure 7.2 for a hypothetical drug, the serum concentration of the
drug reaches the MEC 2 hours after its administration, achieves a peak concentration in
4 hours, and falls below the MEC in 10 hours. If it would be desired to maintain the drug
serum concentration above the MEC for a longer period, a second dose would be required
at about an 8-hour time frame.

For certain drugs, a larger-than-usual initial dose may be required to achieve the
desired blood drug level. This dose is referred to as the priming or loading dose.
Subsequent maintenance doses, similar in amount to usual doses, are then administered
according to the dosage regimen to sustain the desired drug blood levels or drug effects.
To achieve the desired drug blood level rapidly, the loading dose may be administered
as an injection or oral liquid, whereas the subsequent maintenance doses may be
administered in other forms, such as tablets or capsules.

As discussed later in this chapter, there are certain instances in which low-dose
therapy or high-dose therapy is prescribed for a particular patient. And, for certain drugs
there may be different doses required depending on whether the use is for monotherapy,
PHARMACOLOGY FOR NURSING STUDENTS

that is, as the primary drug treatment, or adjunctive therapy, that is, additional to or
supportive of a different primary treatment.

Certain biologic or immunologic products, such as vaccines, may be administered in

prophy- lactic doses to protect the patient from contracting a specific disease. Other
products, such as antitoxins, may be administered in therapeutic doses to counter a
disease after exposure or contraction. The doses of some biologic products, such as
insulin, are expressed in units of activity, derived from biologic assay methods.

Most pharmaceutical products are prepared on a large scale within the pharmaceutical
manufacturing industry for distribution to institutional and community pharmacies. These
prefabricated products and dosage units are used in filling prescriptions and medication
orders in the pharmacy. On a smaller scale, many community and hospital pharmacists
fill prescriptions and medication orders requiring compounding—that is, the fabrication
of a pharmaceutical product from individual ingredients, carefully weighed, measured,
and mixed. Pharmaceutical products may be prepared to contain one or more therapeutic
agents. Products containing more than one therapeutic agent are termed combination
products.

III. Answer the following problems

1. How many capsules, each containing a 150-mcg dose of a drug may be

prepared from 0.12 g of the drug?

2. The following regimen for oral prednisone is prescribed for a patient: 50 mg/
day x 10 days; 25 mg/day x 10 days; 12.5 mg/day x 10 days; 5 mg/day x 10
weeks. How many scored 25-mg tablets and how many 5-mg tablets should be
dispensed to meet the dosing requirements?
PHARMACOLOGY FOR NURSING STUDENTS

3. A physician reduces a patient’s once-daily dose of conjugated estrogen

(PREMARIN) from tablets containing 0.625 mg to tablets containing 0.45 mg. What
is the total reduction in conjugated estrogens taken, in milligrams, during a 30-day
1 month?

4. A fixed-dose combination product contains amlodipine besylate and atorvastatin

calcium (CADUET) for the treatment of both hypertension and
hypercholesterolemia. If a physician starts a patient on a 5- mg/10-mg dose for 14
days and then raises the dose to 10 mg /20 mg, how many milli- grams of each
drug will the patient take during the first 30 days?

5. Prior to a colonoscopy, a patient is in- structed to take OSMOPREP tablets each

of which contains 1.102 g sodium phosphate monobasic monohydrate and 0.398
g sodium phosphate dibasic anhydrous. The dose is:
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 The evening before the procedure: 4 tablets with 8 ounces of clear

liquids every 15 minutes for 5 cycles, and
 Starting 3 to 5 hours before the procedure: 4 tablets with 8 ounces of
clear liquids every 15 minutes for 3 cycles.

How many tablets, how much liquid, and how much total sodium phosphates are
taken?
A. 8tablets,16ouncesliquid,2gsodium phosphates
B. 16 tablets, 1000 mL liquid, 32g sodium phosphates
C. 32 tablets, 1 quart liquid, 40 g sodium phosphates
D. 32 tablets, 0.5 gallon liquid, 48 g sodium phosphates

6. If a cough syrup contains 0.18 g of dextromethorphan HBr in 120 mL, how many
milligrams of the drug are contained in each teaspoonful dose?
PHARMACOLOGY FOR NURSING STUDENTS

7. 17. A cough syrup contains 0.09 g of dextro- methorphan HBr in each fluidounce.
How many milligrams of this agent would be present in each teaspoonful dose?

8. 18. A physician prescribes tetracycline HCl syrup for a patient who is to take 2
teaspoonfuls four times per day for 4 days, and then 1 teaspoonful four times per
day for 2 days. How many milliliters of the syrup should be dispensed to provide
the quantity for the prescribed dosage regimen?
9. How many milliliters of an injection containing 20 mg of gentamicin in each 2 mL
should be used in filling a medication order calling for 2.5 mg of gentamicin to be
administered intramuscularly?

10. A physician ordered 20 mg of MEPER- GAN and 0.3 mg of atropine sulfate to be

administered preoperatively to a patient. MEPERGAN is available in a syringe
containing 25 mg/mL, and atropine sulfate is in an ampule containing 0.4 mg per
0.5 mL. How many milliliters of each should be used in filling the medication
order?

11. How many milliliters of an injection containing 250 mg of aminophylline in each

10 mL should be used in filling a medication order calling for 15 mg of
aminophylline?

12. If a VENTOLIN inhaler contains 20 mg of albuterol, how many inhalation-doses

can be delivered if each inhalation-dose contains 90 mcg?
PHARMACOLOGY FOR NURSING STUDENTS

13. FLONASE Nasal Spray contains 50mcg of fluticasone propionate per actuation
spray in each 100 mg of formulation. Each container provides 120 metered
sprays. How many milligrams of fluticasone propionate are contained in each
container?