PHARMACOLOGY FOR

NURSES

By : Ms. Hadratul Asliyah, S. Farm., Apt

What’s in YOUR scope ?

DOCTORDOCTOR NURSENURSEPHARMACISTPHARMACIST

Diseases diagnosis Diseases diagnosis Care plan Care plan Drug therapy Drug therapy

GOAL ?

HOW TO GET (Y)OUR

COMPETENCY :

- Diseases & its cause - Drug & its therapy - Patient & the treatment

Your focus is here !!!But u can’t left the 2 other ya ^^

NICE QUOTE :

“Terapi Pengobatan yang efektif dan aman hanya dapat dicapai

bila pasien mengetahui seluk beluk pengobatan dan kegunaannya“

This is our JOB !!!

DRUG

DRUG MECHANISM DRUG MECHANISM

DRUG INTERACTIONDRUG INTERACTION

DOSE & CALCULATION

HOW TO ADMINISTER DRUGHOW TO ADMINISTER DRUG

TYPE / CLASS OF DRUGSTYPE / CLASS OF DRUGS

Drugs Calculation

Reference : Reference :

Tambayong, Jan,dr., 2001, Farmakologi untuk Tambayong, Jan,dr., 2001, Farmakologi untuk Keperawatan, Widya Medika, Jakarta. Keperawatan, Widya Medika, Jakarta.

Wallace, Laurence B ; Guide for Calculating Wallace, Laurence B ; Guide for Calculating Medication. Medication. www.jsu.edu/nursing/linkdocs/www.jsu.edu/nursing/linkdocs/DrugDrugCalc/NU325.pdfCalc/NU325.pdf

Starkings, Susan ; Drug Calculation and The Starkings, Susan ; Drug Calculation and The Mathematics Required for Nursing. Mathematics Required for Nursing. www.health.heacademy.ac.uk/rp/resources/articles/sswww.health.heacademy.ac.uk/rp/resources/articles/sstarkingstarkings

Household System VS Metric System

VS Apothecaries System

Household : lbs, c, inch, tea spoon, glass, etcHousehold : lbs, c, inch, tea spoon, glass, etc

Metric : ml, g, gr, kilo, centi, dexa, etcMetric : ml, g, gr, kilo, centi, dexa, etc

Apothecaries : fl oz, cc, etcApothecaries : fl oz, cc, etc Grain gr 1 = 60 mg

Fluid ounces 1 fl oz (US) = 29.57353 ml

*check USP, FI

1 kg = 2.2 lbs

ACCURATE ?

VS

CONVERSIONEXAMPLE : EXAMPLE :

RATIO RATIO PERCENT PERCENT

1 : 5 = …. % 1 : 5 = …. %

1 : 2000 = …. % 1 : 2000 = …. %

PERCENT PERCENT RATIO RATIO

0,02 % = … : …0,02 % = … : …

1,5 % = … : …1,5 % = … : …

2 ------100

1 ------100

X = 2 -----------10.000

1 ----------- 5.000

What is that mean? Is it Solid or Liquid ?

-If it’s SOLID = gram -If it’s LIQUID = mililiter

5 g---------100 g

1 X =5 % = 0,05 g/g = 50 mg/g

HOW TO CALCULATE ?Simple Three-Step Approach to Dosage Calculations:Simple Three-Step Approach to Dosage Calculations:

Step 1: Step 1: ConvertConvert : Ensure all measurements are in the : Ensure all measurements are in the same system of measurement and the same size unit same system of measurement and the same size unit of measurement. If not, convert.of measurement. If not, convert.

Step 2: Step 2: Think WHAT’S AVAILABLEThink WHAT’S AVAILABLE : Estimate what is : Estimate what is a reasonable amount of the drug to be administered. a reasonable amount of the drug to be administered.

Step 3: Step 3: CalculateCalculate : Apply the formula: : Apply the formula: I x Jt T

= X

* I = dosis yg diminta , Jt = Jumlah tersedia , T = dosis yg tersedia , X = hasil

Oral Dosage

How many Digoxin tablets that you need to get How many Digoxin tablets that you need to get 0,125 mg ? *each tablet contain 62,5 mcg Digoxin0,125 mg ? *each tablet contain 62,5 mcg Digoxin

0,125 mg = (0,125 x 1000) mcg = 125 mcg 0,125 mg = (0,125 x 1000) mcg = 125 mcg

I x Jt T

= X125 mcg / X tab 125 mcg x 1 tab ------------------------ = ------------------------- = 2 tab 62,5 mcg / 1 tab 62,5 mcg

Injection Dosage

The physician ordered Phenobarbital 30 mg. The physician ordered Phenobarbital 30 mg. you have on hand an ampule of Phenobarbital you have on hand an ampule of Phenobarbital containing 60 mg per 5 ml. how many ml of containing 60 mg per 5 ml. how many ml of medication will you give? medication will you give?

I x Jt T

= X30 mg / X ml 30 mg x 5 ml ------------------ = --------------------- = 2,5 ml 60 mg / 5 ml 60 mg

Injection Dosage

The physician ordered Morphine 4 mg IM. You The physician ordered Morphine 4 mg IM. You have Morphine containing 10 mg in 2 ml. How have Morphine containing 10 mg in 2 ml. How many ml should you give? Chose many ml should you give? Chose the correct the correct syringe syringe and shade in the appropriate amount and shade in the appropriate amount of medication.of medication.I x Jt

T= X

4 mg / X ml 4 mg x 2 ml ------------------ = -------------------- = 0,8 ml 10 mg / 2 ml 10 mg

Intravena Dose (infusion rate)Formula for Calculating Intravenous Fluids Formula for Calculating Intravenous Fluids

total ml fluid to be giventotal ml fluid to be given1. ml/hr 1. ml/hr -------------------------------- = desired ml/hr -------------------------------- = desired ml/hr

hours to be infusedhours to be infused

desired volume x drop factor desired volume x drop factor 2. drops/min 2. drops/min ------------------------------------- = ------------------------------------- = desired desired gtts/minutes gtts/minutes

total number of minutes total number of minutes

Jumlah tetesan / ml larutan

Infusion Dosage

Physician Physician orders 2000 ml orders 2000 ml of fluids to of fluids to infuse in 16 infuse in 16 hours.hours. You have available the Baxter administration You have available the Baxter administration set with set with drop factor of 10drop factor of 10. how many . how many cc/hour cc/hour should should fluids infuse? And how many fluids infuse? And how many drops/minutesdrops/minutes? ?

Desired volume : 2000 ml Desired volume : 2000 ml

Drop factor : 10 Drop factor : 10

Total number of minutes = 16 hour = 16 x 60 Total number of minutes = 16 hour = 16 x 60 minutes = 960 minutes minutes = 960 minutes

ml/hr

total ml fluid to be giventotal ml fluid to be given ml/hr ml/hr -------------------------------- = desired ml/hr -------------------------------- = desired ml/hr

hours to be infusedhours to be infused

2000 ml2000 ml -------------- = 125 ml/hr = 125 cc/hr-------------- = 125 ml/hr = 125 cc/hr

16 hr16 hr

* 1 cc = 1 ml * 1 cc = 1 ml

Hour = jam

drops/minutes

desired volume x drop factor desired volume x drop factor

drops/min drops/min ------------------------------------- = ------------------------------------- = desired desired gtts/minutes gtts/minutes

total number of minutes total number of minutes

2000 x 102000 x 10

--------------- = --------------- = 28,3 gtts/minutes 28,3 gtts/minutes

960960

Pediatric dosages

RULE : to verify safe pediatric dosing RULE : to verify safe pediatric dosing

1.1.convert convert the child’s weight (if it’s different)the child’s weight (if it’s different)

2.2.calculatecalculate the safe dosage in mg/kg or mcg/kg the safe dosage in mg/kg or mcg/kg as recommendedas recommended

3.3.CompareCompare the ordered dose to the the ordered dose to the recommended dose and recommended dose and decidedecide if the dosage is if the dosage is safesafe

How to convert Adult Dose to

Child Dose (pediatric) ?RUMUS MENGHITUNG DOSIS:RUMUS MENGHITUNG DOSIS:

CLARKCLARK : : ww/70 x /70 x DM Dewasa DewasaYOUNGYOUNG : : ww/(n+20) X DM Dewasa /(n+20) X DM Dewasa

DILLINGDILLING : : nn/20 X DM Dewasa /20 X DM Dewasa COWLINGCOWLING : ( : (nn+1)/24 X DM Dewasa +1)/24 X DM Dewasa

FRIEDFRIED : : mm/150 X DM Dewasa /150 X DM Dewasa dosis Bayi dosis Bayi

Keterangan :Keterangan :W = Berat Badan ( Kg )W = Berat Badan ( Kg )n = Umur ( tahun )n = Umur ( tahun )m = Umur ( bulan)m = Umur ( bulan)

DOSIS OBAT Dosis suatu obat : adalah dosis pemakaian sekali untuk peroral atau Dosis suatu obat : adalah dosis pemakaian sekali untuk peroral atau injeksi,Dalam pemberian terapi obat yg rasionalinjeksi,Dalam pemberian terapi obat yg rasional

DOSIS TERAPI (DT) DOSIS TERAPI (DT) Dosis individual yg tertulis di resep dg tujuan pengobatanDosis individual yg tertulis di resep dg tujuan pengobatan

DOSIS LAZIM (DL) DOSIS LAZIM (DL) Dosis yang tercantum di literatur yg lazimnya dapat menyembuhkan, Dosis yang tercantum di literatur yg lazimnya dapat menyembuhkan, dosis tersebut sebagai acuan dalam menetapkan dosis terapi per dosis tersebut sebagai acuan dalam menetapkan dosis terapi per individual individual Contoh : Erithromicin Contoh : Erithromicin Sekali minum : 250 mg – 500 mgSekali minum : 250 mg – 500 mgSeharinya : 1000 mg – 2000 mg Seharinya : 1000 mg – 2000 mg

DOSIS MAKSIMUM DOSIS MAKSIMUM (DM) (DM) Dosis terbesar yg dpt memberikan efek terapi tanpa menimbulkan bahaya Dosis terbesar yg dpt memberikan efek terapi tanpa menimbulkan bahaya Contoh : Erithromicin Contoh : Erithromicin Sekali minum : 500 mgSekali minum : 500 mgSeharinya : 4000 mgSeharinya : 4000 mg

How to convert Adult Dose to Child Dose (pediatric) ?

Berdasarkan Luas Permukaan Tubuh (BSA)Berdasarkan Luas Permukaan Tubuh (BSA)

LUAS PERMUKAAN TUBUH (mLUAS PERMUKAAN TUBUH (m22) ) DOSIS PEDIATRI = ------------------------------------------------- x Dosis DewasaDOSIS PEDIATRI = ------------------------------------------------- x Dosis Dewasa

1,731,73

See See : Pediatric Dose Chart

Example :

The physician orders morphine sulfate 1.8 mg IM stat. The child The physician orders morphine sulfate 1.8 mg IM stat. The child weighs 79 lbweighs 79 lb. Is this dosage safe?. Is this dosage safe?

Step 1: Convert lbs. to kilograms (2.2 lb. = 1 kg)Step 1: Convert lbs. to kilograms (2.2 lb. = 1 kg)

79 / 2.2 = 35.91 or 35.9 kg.79 / 2.2 = 35.91 or 35.9 kg.

Step 2: Calculate mg/kg as recommended by a reputable drug resource. (A Step 2: Calculate mg/kg as recommended by a reputable drug resource. (A reputable drug resource indicates that the usual IM/SC dosage may be reputable drug resource indicates that the usual IM/SC dosage may be initiated at 0.05 mg/kg/dose.)initiated at 0.05 mg/kg/dose.)

Per dose= 35.9 kg x 0.05 mg = 1.79 mg = 1.8 mg/dosePer dose= 35.9 kg x 0.05 mg = 1.79 mg = 1.8 mg/dose

Step 3: Decide if the dosage is safe by comparing ordered and recommended Step 3: Decide if the dosage is safe by comparing ordered and recommended dosages. For this child’s weight, 1.8 mg is the recommended dosage and 1.8 dosages. For this child’s weight, 1.8 mg is the recommended dosage and 1.8

mg is the ordered dosage. Yes, the order mg is the ordered dosage. Yes, the order is safe.is safe.

EXAMPLE :

The physician’s order reads “The physician’s order reads “KeflinKeflin” ” 1000 mg1000 mg. . IV q6hrsIV q6hrs.” The PDR gives the dosage range as .” The PDR gives the dosage range as 50-80 mg. per kg. per day to be given in 50-80 mg. per kg. per day to be given in divided doses of q 8 hours. The child divided doses of q 8 hours. The child weighs weighs 32 pounds.32 pounds. ? Is the dosage ordered in the safe ? Is the dosage ordered in the safe range? _____If so, How many mg should be range? _____If so, How many mg should be given per dose? _____________given per dose? _____________

Answer :

The PDR gives the dosage range as 50-80 mg. per The PDR gives the dosage range as 50-80 mg. per kg. per day to be given in divided doses of q 8 kg. per day to be given in divided doses of q 8 hours. The child hours. The child weighs 32 poundsweighs 32 pounds..

32 lbs = …. Kg 32 lbs = …. Kg 32 / 2.2 = 14.5 kg 32 / 2.2 = 14.5 kg

recommended dose = recommended dose =

50-80 mg/kg/day 50-80 mg/kg/day 50 mg/kg/day x 14.5 kg = 50 mg/kg/day x 14.5 kg = 725 mg/day 725 mg/day

80 mg/kg/day x 14.5 kg = 80 mg/kg/day x 14.5 kg = 1160 mg/day1160 mg/day

Cont…

The physician’s order reads “The physician’s order reads “KeflinKeflin” ” 1000 mg1000 mg. . IV IV q6hrsq6hrs

recommended dose = recommended dose = 725 mg/day – 1160 mg/day725 mg/day – 1160 mg/day

it means that the dosage it means that the dosage is NOT in the is NOT in the safe range. safe range.

How many mg should be given per dose? How many mg should be given per dose?

ifif 1000 mg / day = …… mg/ 6 hours 1000 mg / day = …… mg/ 6 hours

1000 mg / 24 hours 1000 mg x 6 hours---------------------------- = ----------------------------- = 250 mg q6hrs X mg / 6 hours 24 hours

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TRY TO ANSWER THIS :

A 50-pound child is to receive 0.2 mg/kg. How many A 50-pound child is to receive 0.2 mg/kg. How many mg. of a medication is the correct dose for this child?mg. of a medication is the correct dose for this child?

Albuterol 1.2 mg po t.i.d. for an 18 kg child with severe Albuterol 1.2 mg po t.i.d. for an 18 kg child with severe asthma. Recommended dosage from the manufacturer: asthma. Recommended dosage from the manufacturer: 0.2mg/kg/day orally in three equally divided doses. Is 0.2mg/kg/day orally in three equally divided doses. Is the order safe?the order safe?

Ordered: Dilantin 30 mg T.I.D. PO for a 2 year old child Ordered: Dilantin 30 mg T.I.D. PO for a 2 year old child weighing 39.6 pounds. Safe dose for this age group is weighing 39.6 pounds. Safe dose for this age group is 5mg/kg/day. On hand is Dilantin Pediatric Suspension 5mg/kg/day. On hand is Dilantin Pediatric Suspension 125mg/5ml. How many ml. would you give per dose?125mg/5ml. How many ml. would you give per dose?

ALHAMDU….. LILLAH…