🌟 DRUG ADMINISTRATION – ABBREVIATIONS 🌟

💉 “Understand the codes, deliver safe doses!”

Abbreviations are commonly used in prescriptions and medication charts to indicate the timing, route, and dosage of drug administration.

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📘 TIME-RELATED ABBREVIATIONS

⏰ Abbreviation	🗓️ Meaning	💡 Example
OD	Once daily	1 dose per day
BD / BID	Twice daily	Every 12 hrs
TDS / TID	Thrice daily	Every 8 hrs
QID	Four times daily	Every 6 hrs
QHS	Every night at bedtime	Night dose
Q4H / Q6H	Every 4 / 6 hours	Based on condition
PRN	When necessary	Pain, fever
STAT	Immediately	Emergency drug
AC	Before meals	Take before eating
PC	After meals	Take after eating
HS	At bedtime	Sedatives, night drugs

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🚨 ROUTE OF ADMINISTRATION ABBREVIATIONS

💉 Abbreviation	🌐 Route	💡 Example
PO	By mouth (oral)	Tablet, syrup
IV	Intravenous	Fluids, antibiotics
IM	Intramuscular	Vaccines
SC / SQ	Subcutaneous	Insulin
ID	Intradermal	Allergy tests, Mantoux
SL	Sublingual	Nitroglycerin
PR	Per rectum	Suppositories
INH	Inhalation	Asthma meds
TOP / TD	Topical / Transdermal	Creams, patches
BUCCAL	Between gum & cheek	Lozenges

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📏 DOSAGE & FREQUENCY ABBREVIATIONS

🔢 Abbreviation	🧾 Meaning
mg	Milligram
ml / mL	Milliliter
g / gm	Gram
IU	International Unit
cc	Cubic centimeter (same as mL)
tab	Tablet
cap	Capsule
amp	Ampoule
vial	Small glass bottle
gtt	Drops
supp	Suppository

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🧠 MISCELLANEOUS ABBREVIATIONS

🧾 Abbreviation	📘 Meaning
Rx	Prescription
NPO	Nothing by mouth (nil per os)
SOS	If needed in emergency
NR	No refill
KVO / TKO	Keep vein open / To keep open (IV)
Ad lib	As desired
Sig.	Directions to be followed

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⚠️ SAFETY TIPS FOR NURSES

✅ Always verify unfamiliar abbreviations
✅ Use approved abbreviations only
✅ Clarify ambiguous or illegible orders
✅ Do not use banned abbreviations (e.g., “U” for units)
✅ Document time, dose, and route clearly
✅ Cross-check all 10 Rights of Medication Administration

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📌 MOST ASKED EXAM QUESTIONS (MCQ STYLE)

✅ Q: What does ‘TDS’ mean in a prescription?
🅰️ Thrice daily

✅ Q: What is the meaning of ‘PRN’?
🅰️ When necessary

✅ Q: ‘PO’ route of drug means?
🅰️ By mouth (oral)

✅ Q: What does ‘STAT’ signify?
🅰️ Immediately

✅ Q: What is the abbreviation for subcutaneous injection?
🅰️ SC or SQ

🌟 COMMON NURSING DRUG CLASSES 🌟

💉 “Know your drugs — they save lives when used right.”

Understanding drug classes helps nurses ensure safe administration, monitor for side effects, and educate patients effectively.

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🧾 1️⃣ ANALGESICS (Pain Relievers) 💊

💡 Example Drugs	🔍 Common Names
Non-opioid	Paracetamol, Ibuprofen
Opioid	Morphine, Tramadol, Fentanyl

Uses: Pain, fever, post-op
Nursing Tip: Monitor respiratory rate for opioids

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🧾 2️⃣ ANTIBIOTICS (Antibacterial Agents) 🦠

💡 Example Classes	🔍 Common Drugs
Penicillins	Amoxicillin, Ampicillin
Cephalosporins	Ceftriaxone, Cefixime
Macrolides	Azithromycin, Erythromycin
Fluoroquinolones	Ciprofloxacin, Levofloxacin

Uses: Bacterial infections
Nursing Tip: Watch for allergies and superinfections

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🧾 3️⃣ ANTIPYRETICS (Fever Reducers) 🌡️

💊 Common Drugs
Paracetamol, Ibuprofen

Uses: Fever, mild pain
Nursing Tip: Assess temperature and hydration status

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🧾 4️⃣ ANTIHYPERTENSIVES (BP Lowering Agents) ❤️

💡 Class	🔍 Example Drugs
ACE Inhibitors	Enalapril, Lisinopril
Beta-blockers	Metoprolol, Atenolol
Calcium Channel Blockers	Amlodipine, Verapamil
Diuretics	Furosemide, Hydrochlorothiazide

Uses: Hypertension, heart failure
Nursing Tip: Check BP, pulse before giving

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🧾 5️⃣ ANTI-DIABETIC DRUGS 🍬

💊 Type	🔍 Example
Oral	Metformin, Glibenclamide
Insulin	Regular, NPH, Lispro

Uses: Type 1 & 2 Diabetes Mellitus
Nursing Tip: Monitor blood glucose, signs of hypoglycemia

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🧾 6️⃣ ANTIEMETICS (Prevent Nausea/Vomiting) 🤢

💊 Common Drugs
Ondansetron, Metoclopramide, Domperidone

Uses: Nausea from chemo, post-op
Nursing Tip: Watch for sedation, extrapyramidal symptoms

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🧾 7️⃣ ANTI-ULCER DRUGS (Acid Reducers) 🥴

💡 Type	🔍 Examples
H2 Blockers	Ranitidine, Famotidine
PPIs	Pantoprazole, Omeprazole

Uses: Gastric ulcers, GERD
Nursing Tip: Give before meals; monitor for GI bleeding

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🧾 8️⃣ BRONCHODILATORS (Open Airways) 🫁

💊 Common Drugs
Salbutamol, Ipratropium, Theophylline

Uses: Asthma, COPD
Nursing Tip: Monitor respiratory rate, wheezing

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🧾 9️⃣ ANTIHISTAMINES (Allergy Meds) 🌸

💊 Common Drugs
Cetirizine, Chlorpheniramine, Loratadine

Uses: Allergies, rashes, runny nose
Nursing Tip: Caution with drowsiness, avoid alcohol

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🧾 🔟 ANTICONVULSANTS (Seizure Control) ⚡

💊 Common Drugs
Phenytoin, Valproic acid, Carbamazepine

Uses: Epilepsy, seizure prevention
Nursing Tip: Monitor drug levels, oral hygiene (gingival hyperplasia)

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📌 MOST ASKED EXAM QUESTIONS (MCQ STYLE)

✅ Q: Which class of drug is Enalapril?
🅰️ Antihypertensive (ACE Inhibitor)

✅ Q: Metformin is used to treat?
🅰️ Type 2 Diabetes

✅ Q: Name a common side effect of opioids.
🅰️ Respiratory depression

✅ Q: What should be checked before giving Furosemide?
🅰️ Blood pressure and potassium level

✅ Q: Which drug is used as a bronchodilator?
🅰️ Salbutamol

🌟 LOOK-ALIKE SOUND-ALIKE (LASA) MEDICATIONS 🌟

💊 “One letter off can be a life lost — identify LASA to protect your patients.”

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📘 DEFINITION

🗨️ LASA medications are drugs that look similar in packaging or name or sound alike when spoken, increasing the risk of medication errors in prescribing, dispensing, or administration.

✅ These are recognized by WHO, ISMP, and health authorities as high-risk if confused.

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🧠 WHY LASA DRUGS ARE DANGEROUS

🔸 Can result in wrong drug, wrong patient, wrong dose
🔸 May cause serious adverse reactions or fatal outcomes
🔸 Occurs during prescription, transcription, dispensing, or administration

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🔥 COMMON EXAMPLES OF LASA MEDICATIONS

❗ Look-Alike / Sound-Alike Pair	💡 Potential Confusion
Celebrex vs Celexa	Pain relief vs Antidepressant
Hydroxyzine vs Hydralazine	Antihistamine vs Antihypertensive
Adderall vs Inderal	ADHD vs Hypertension
Zantac vs Zyrtec	GERD vs Allergy
Clonidine vs Klonopin	BP vs Anti-anxiety/seizures
Lamisil vs Lamictal	Antifungal vs Anticonvulsant
Amaryl vs Reminyl	Diabetes vs Dementia
Tramadol vs Toradol	Pain relievers (but different types)
Tegretol vs Topamax	Antiepileptics (used in different seizure types)
Metformin vs Methotrexate	Diabetes vs Cancer/Autoimmune

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🧤 NURSE’S ROLE IN PREVENTING LASA ERRORS

👩‍⚕️ “Double-check to protect.”

🔹 Read full drug names — avoid abbreviations
🔹 Cross-check drug name, dose, and indication
🔹 Use Tall Man lettering (e.g., hydrOXYzine vs hydrALAzine)
🔹 Confirm with pharmacist or prescriber if unclear
🔹 Educate patients on correct drug name and use
🔹 Store LASA drugs separately in storage/med carts
🔹 Use barcode scanning if available

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📚 WHAT IS TALL MAN LETTERING?

🖊️ A safety strategy to capitalize dissimilar parts of LASA drug names for better visibility.

🔸 Example:

• hydrALAzine vs hydrOXYzine
• DOBUTamine vs DOPamine
• predniSONE vs prednisoLONE

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📌 MOST ASKED EXAM QUESTIONS (MCQ STYLE)

✅ Q: What does LASA stand for in medication safety?
🅰️ Look-Alike Sound-Alike

✅ Q: Which strategy is used to reduce LASA errors?
🅰️ Tall Man Lettering

✅ Q: Which of the following is a LASA pair?
🅰️ Clonidine and Klonopin

✅ Q: What is the nurse’s role in preventing LASA errors?
🅰️ Double-check drug name, dose, and route before giving

✅ Q: What is a common LASA error with Metformin?
🅰️ Confused with Methotrexate

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📌 QUICK TIPS TO PREVENT LASA ERRORS

✅ Read aloud the medication name
✅ Always check 3 times before administering
✅ Use standardized medication charts
✅ Educate patients about their medications
✅ Report and document near-miss errors

🌟 HIGH ALERT MEDICATIONS 🌟

💉 “Handle with care — these meds demand double-checks everywhere.”

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📘 DEFINITION

🗨️ High Alert Medications are drugs that carry a higher risk of causing significant harm or life-threatening complications if used in error, even when used at normal doses.

✅ Recognized by ISMP (Institute for Safe Medication Practices) and WHO.

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🚨 CATEGORIES OF HIGH ALERT DRUGS

💉 1️⃣ INSULINS

🔹 Rapid, short, intermediate, long-acting
🔸 Risk: Hypoglycemia, overdose
🔹 Nursing Tip: Use insulin-specific syringe; double-check dose and type
🔹 E.g.: Insulin Regular, Glargine, Lispro

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💉 2️⃣ ANTICOAGULANTS

🔸 Risk: Internal bleeding, INR abnormalities
🔹 Monitor: INR, PT, aPTT, bleeding signs
🔹 E.g.: Heparin, Warfarin, Enoxaparin

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💉 3️⃣ CHEMOTHERAPY DRUGS

🔸 Risk: Severe tissue damage, immunosuppression
🔹 Handle with PPE and chemo precautions
🔹 E.g.: Methotrexate, Doxorubicin, Cyclophosphamide

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💉 4️⃣ OPIOIDS / NARCOTICS

🔸 Risk: Respiratory depression, sedation, dependence
🔹 Monitor RR, sedation score, pain scale
🔹 E.g.: Morphine, Fentanyl, Tramadol

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💉 5️⃣ ELECTROLYTES (Concentrated)

🔸 Risk: Cardiac arrest, seizures
🔹 Never push concentrated KCl
🔹 E.g.: Potassium chloride, Magnesium sulfate, Calcium gluconate

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💉 6️⃣ SEDATIVES & ANESTHETICS

🔸 Risk: Airway compromise, deep sedation
🔹 Use only under monitoring
🔹 E.g.: Midazolam, Propofol, Lorazepam

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🧠 NURSE’S RESPONSIBILITIES FOR HIGH ALERT DRUGS

👩‍⚕️
✅ Double-check with another licensed nurse
✅ Use standard protocols or infusion pumps
✅ Clearly label syringes & infusions
✅ Monitor vital signs, lab values, consciousness level
✅ Educate patient/family about risks
✅ Store securely and separate from regular meds

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🌟 MEDICATION ERROR REPORTING 🌟

🛑 “Report to prevent — learn from errors, don’t hide them.”

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📘 DEFINITION

🗨️ A medication error is any preventable event that may cause or lead to inappropriate medication use or harm to a patient.

✅ Includes wrong dose, drug, route, patient, time, or documentation errors.

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🔍 TYPES OF MEDICATION ERRORS

❌ Error Type	💡 Example
Prescribing error	Wrong drug/dose prescribed
Transcription error	Misreading prescription
Dispensing error	Pharmacist gives wrong medication
Administration error	Wrong route, time, or patient
Omission error	Skipping a scheduled dose

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🧾 WHAT TO INCLUDE IN A MEDICATION ERROR REPORT

✔️ Patient’s name & ID
✔️ Date/time of error
✔️ Drug name, dose, route, and actual error
✔️ Condition of patient after error
✔️ Actions taken (e.g., doctor informed, antidote given)
✔️ Name of person reporting

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⚖️ PRINCIPLES OF ERROR REPORTING

🔹 Non-punitive: Not for blaming — it’s for learning
🔹 Confidential: Patient and nurse identities are protected
🔹 Timely: Report as soon as possible
🔹 Follow hospital policy and use Incident Report Forms

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📌 MOST ASKED EXAM QUESTIONS (MCQ STYLE)

✅ Q: What are high alert medications?
🅰️ Drugs that can cause significant harm if used incorrectly

✅ Q: What must be done before giving insulin?
🅰️ Double-check type and dose with another nurse

✅ Q: What is the first step when a medication error is found?
🅰️ Assess the patient and notify the physician

✅ Q: Is it okay to hide a medication error if no harm occurred?
🅰️ No — all errors must be reported

✅ Q: Which electrolyte should never be given as IV push?
🅰️ Potassium chloride (KCl)

🌟 ROUTES OF DRUG ADMINISTRATION 🌟

💉 “Right route = Right effect — Know where and how to give.”

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📘 DEFINITION

🗨️ Route of drug administration refers to the path by which a drug is taken into the body to produce its intended therapeutic effect.

✅ Route affects absorption, onset, duration, and effectiveness of the medication.

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🧭 CLASSIFICATION OF ROUTES

🔹 1️⃣ Enteral Route (via GI tract)

🔹 2️⃣ Parenteral Route (bypasses GI tract)

🔹 3️⃣ Topical & Local Routes (applied on skin or mucous membranes)

🔹 4️⃣ Inhalational Route (via respiratory tract)

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💊 1️⃣ ENTERAL ROUTE (Oral/Through GI Tract)

📍 Route	💡 Description	🧪 Example
Oral (PO)	Swallowed by mouth	Tablets, syrups
Sublingual (SL)	Under the tongue	Nitroglycerin
Buccal	Between gum & cheek	Lozenges
Rectal (PR)	Suppositories via rectum	Glycerin, Diazepam

🧠 Nursing Tip: Avoid oral route in vomiting, unconscious, or NPO patients.

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💉 2️⃣ PARENTERAL ROUTE (Injection)

📍 Route	💡 Description	🧪 Common Use
Intravenous (IV)	Into vein	Immediate effect
Intramuscular (IM)	Into muscle	Vaccines, pain relief
Subcutaneous (SC/SQ)	Into fatty tissue	Insulin, Heparin
Intradermal (ID)	Into skin layer	Mantoux test, allergy testing
Intra-arterial / Intra-articular	Specialized cases	Chemotherapy, joint injections

🧠 Nursing Tip: Use aseptic technique, rotate sites, check for allergic reactions.

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🧴 3️⃣ TOPICAL / LOCAL ROUTES

📍 Route	💡 Description	🧪 Example
Topical (skin)	Applied directly to skin	Creams, ointments
Ophthalmic	Eye drops or ointments	Antibiotic eye drops
Otic	Ear drops	Wax softeners
Nasal	Nasal sprays/drops	Decongestants
Vaginal	Pessaries, creams	Antifungals

🧠 Nursing Tip: Ensure area is clean before application; wear gloves.

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🌬️ 4️⃣ INHALATIONAL ROUTE

📍 Route	💡 Description	🧪 Example
Inhalers	Metered dose directly into lungs	Salbutamol (asthma)
Nebulizers	Converts liquid into mist	Budesonide
Oxygen Therapy	Nasal cannula, face mask	Hypoxia treatment

🧠 Nursing Tip: Teach proper technique and monitor respiratory rate.

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🧠 FACTORS AFFECTING ROUTE SELECTION

🔹 Age and consciousness
🔹 Speed of action required
🔹 Type and form of drug
🔹 Condition of GI tract or injection sites
🔹 Risk of infection, bleeding
🔹 Patient comfort and compliance

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📌 MOST ASKED EXAM QUESTIONS (MCQ STYLE)

✅ Q: Which route gives the fastest drug effect?
🅰️ Intravenous (IV)

✅ Q: What does PO mean in a prescription?
🅰️ By mouth (oral)

✅ Q: Which route is used for tuberculosis skin test?
🅰️ Intradermal

✅ Q: What is the sublingual route used for?
🅰️ Drugs that need fast absorption like Nitroglycerin

✅ Q: When should the oral route be avoided?
🅰️ Unconscious, vomiting, or NPO patients

🌟 FACTORS AFFECTING DRUG ABSORPTION 🌟

💉 “Absorption determines action — what the body gets, the body uses.”

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📘 DEFINITION

🗨️ Drug absorption refers to the movement of a drug from the site of administration into the bloodstream for distribution to the tissues.

✅ Absorption influences the onset, intensity, and duration of drug action.

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🧠 MAIN FACTORS AFFECTING DRUG ABSORPTION

🔢 Factor	💡 Explanation	📍 Nursing Consideration
1️⃣ Route of Administration	IV is fastest; oral is slower	Choose route based on urgency
2️⃣ Form of Drug	Liquid > Tablet > Enteric-coated	Liquid has quicker onset
3️⃣ Blood Flow to Site	Good perfusion ↑ absorption	Avoid injections in cold/poorly perfused areas
4️⃣ GI Motility	Rapid motility ↓ absorption	Diarrhea may reduce oral drug effect
5️⃣ Surface Area	Larger area = faster absorption	Small intestine absorbs better than stomach
6️⃣ Lipid Solubility	Lipid-soluble drugs cross membranes easily	Rapid onset in lipid-rich tissues
7️⃣ pH of Environment	Acidic drugs absorb in stomach, alkaline in intestine	Antacids may alter absorption
8️⃣ Presence of Food	May delay or inhibit drug absorption	Some drugs should be taken on empty stomach
9️⃣ Drug Interactions	Some drugs bind to others and reduce absorption	E.g., calcium reduces absorption of tetracycline
🔟 Patient Factors	Age, illness, GI surgery, enzyme levels	Elderly and infants have altered absorption rates

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📊 ABSORPTION SPEED COMPARISON (Common Routes)

🚀 Speed	📍 Route
🚀 Fastest	IV (Intravenous)
⚡ Fast	IM > SC > Sublingual
🕗 Moderate	Oral (PO), Rectal
🐢 Slow	Transdermal, Topical

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📌 MOST ASKED EXAM QUESTIONS (MCQ STYLE)

✅ Q: Which route has 100% absorption?
🅰️ Intravenous (IV)

✅ Q: What affects oral drug absorption the most?
🅰️ GI motility and food in the stomach

✅ Q: Lipid-soluble drugs are absorbed faster because…?
🅰️ They cross cell membranes easily

✅ Q: Which organ is primary for drug absorption in enteral route?
🅰️ Small intestine

✅ Q: What effect does diarrhea have on absorption?
🅰️ Decreases drug absorption

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👩‍⚕️ NURSE’S RESPONSIBILITIES

🔹 Administer drugs as per correct route
🔹 Educate patient on timing with food (before/after meals)
🔹 Monitor for delayed or reduced effects in patients with GI issues
🔹 Check for drug–food or drug–drug interactions
🔹 Adjust routes in case of vomiting, diarrhea, or poor circulation

🌟 BIOAVAILABILITY & PHARMACOKINETICS 🌟

💊 “From pill to plasma — understanding the drug journey.”

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📘 BIOAVAILABILITY

🧠 Definition:

🗨️ Bioavailability refers to the fraction (percentage) of the administered drug dose that reaches the systemic circulation in an active form.

✅ It determines the effectiveness of the drug.

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🔬 KEY POINTS:

• IV route = 💯 100% bioavailability (directly enters bloodstream)
• Oral route = 👇 Decreased due to first-pass metabolism in the liver
• Affected by:
  🔹 Drug formulation
  🔹 GI absorption
  🔹 Liver metabolism
  🔹 Route of administration

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🧪 EXAMPLE:

💉 Route	🔢 Bioavailability
IV (Intravenous)	100%
IM (Intramuscular)	~75–100%
SC (Subcutaneous)	~75–100%
PO (Oral)	~40–70%
PR (Rectal)	~50–80%

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📌 MCQ TIP:

✅ Q: What is the bioavailability of IV drugs?
🅰️ 100%

✅ Q: What reduces oral drug bioavailability?
🅰️ First-pass metabolism in the liver

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🌟 PHARMACOKINETICS

📈 “What the body does to the drug.”

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🧬 FOUR PHASES (ADME)

🔠 Phase	🧾 Description	🧠 Key Considerations
🅰️ Absorption	Movement from site → bloodstream	Affected by food, pH, motility
🅳 Distribution	Transport via blood to tissues	Affected by protein binding, circulation
🅼 Metabolism	Drug breakdown (mostly in liver)	First-pass effect, enzyme levels
🅴 Excretion	Elimination from body (mostly kidney)	Urine output, renal function tests

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🔁 PHARMACOKINETIC TERMS TO REMEMBER

🔤 Term	📘 Meaning
Half-life (t½)	Time for 50% of drug to be eliminated
Onset of Action	Time till drug starts working
Peak	Time when drug has maximum effect
Duration	Total time drug remains effective
Steady State	Drug intake = elimination (maintained level)

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🧠 EXAMPLE: Paracetamol

• Onset: 30 minutes
• Peak: 1–2 hours
• Duration: 4–6 hours
• Half-life: 2–3 hours

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👩‍⚕️ NURSE’S RESPONSIBILITIES IN PHARMACOKINETICS

🔹 Time medication accurately (match peak/trough)
🔹 Assess renal & liver function
🔹 Observe for signs of toxicity or underdosing
🔹 Educate patients on drug timing & food interaction
🔹 Monitor blood levels for drugs with narrow therapeutic index (e.g., Digoxin, Phenytoin)

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📌 MOST ASKED EXAM QUESTIONS (MCQ STYLE)

✅ Q: What does pharmacokinetics study?
🅰️ How the body absorbs, distributes, metabolizes, and excretes a drug

✅ Q: Which organ is primary for drug metabolism?
🅰️ Liver

✅ Q: What is the meaning of half-life?
🅰️ Time required for 50% of drug to be eliminated from body

✅ Q: What affects drug distribution?
🅰️ Protein binding and blood flow

✅ Q: Which phase is bypassed in IV administration?
🅰️ Absorption

🌟 PHARMACODYNAMICS 🌟

🧬 “What the drug does to the body.”

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📘 DEFINITION

🗨️ Pharmacodynamics is the study of the biological and physiological effects of drugs on the body and their mechanism of action (MOA).

✅ It explains how and why a drug works.

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🧠 KEY CONCEPTS IN PHARMACODYNAMICS

💡 Concept	📖 Explanation
Drug-Receptor Interaction	Drugs bind to receptors to produce action
Agonist	Activates a receptor → full response
Antagonist	Blocks receptor → prevents response
Potency	Dose required to produce a specific effect
Efficacy	Maximum effect a drug can produce
Therapeutic Index (TI)	Margin of safety between effective & toxic dose
Dose–Response Relationship	Higher dose = greater response (to a limit)

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🧬 EXAMPLE:

💊 Drug	🧠 Effect
Morphine (Agonist)	Binds to opioid receptors → pain relief
Naloxone (Antagonist)	Blocks opioid receptors → reverses morphine overdose

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🧠 NURSE’S ROLE IN PHARMACODYNAMICS

👩‍⚕️
🔹 Understand mechanism & effect of each drug
🔹 Assess therapeutic response vs side effects
🔹 Be aware of onset, peak, and duration
🔹 Adjust care according to patient response

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📌 MOST ASKED EXAM QUESTIONS (MCQ STYLE)

✅ Q: What does pharmacodynamics study?
🅰️ The effects of drugs on the body

✅ Q: What is the function of an antagonist drug?
🅰️ To block a receptor site

✅ Q: Which term describes the strength of drug response?
🅰️ Efficacy

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🌟 THERAPEUTIC DRUG MONITORING (TDM) 🌟

📊 “Check the levels — protect the patient.”

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📘 DEFINITION

🗨️ TDM is the measurement of drug concentration in blood at specific intervals to maintain therapeutic levels and avoid toxicity.

✅ Used for drugs with narrow therapeutic index.

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🎯 PURPOSE OF TDM

✔️ Ensure therapeutic effectiveness
✔️ Prevent drug toxicity
✔️ Adjust dosage regimen
✔️ Monitor patient compliance

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🔬 DRUGS COMMONLY MONITORED WITH TDM

💊 Drug	🧠 Reason
Digoxin	Cardiac drug → narrow margin
Phenytoin	Anti-epileptic → neurotoxicity risk
Lithium	Mood stabilizer → nephrotoxic
Theophylline	Bronchodilator → toxicity risk
Vancomycin	Antibiotic → kidney function concern
Gentamicin	Aminoglycoside → ototoxic, nephrotoxic

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🕒 TIMING IN TDM

📌 Time	🧾 Purpose
Peak Level	Highest concentration (shows efficacy)
Trough Level	Lowest concentration before next dose (shows safety)

🔸 Trough is usually measured just before the next dose
🔸 Peak is measured 1–2 hrs after oral, 30 mins after IV

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🧠 NURSE’S ROLE IN TDM

👩‍⚕️
🔹 Know when to draw peak and trough levels
🔹 Ensure proper sample collection & labeling
🔹 Educate patients about timing and compliance
🔹 Monitor for side effects or toxicity signs
🔹 Collaborate with pharmacist/physician for dose adjustment

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📌 MOST ASKED EXAM QUESTIONS (MCQ STYLE)

✅ Q: What is TDM used for?
🅰️ To maintain drug levels within therapeutic range

✅ Q: Which drug requires TDM due to toxicity risk?
🅰️ Phenytoin, Digoxin, Lithium

✅ Q: When is a trough level drawn?
🅰️ Just before the next dose

✅ Q: What does a peak level indicate?
🅰️ Drug efficacy (highest blood concentration)

🌟 ADVERSE DRUG REACTIONS (ADR) 🌟

💥 “Not all effects are intended — some need immediate attention.”

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📘 DEFINITION

🗨️ Adverse Drug Reaction is any unwanted, harmful, or unexpected reaction to a drug given at normal dose for treatment or diagnosis.

✅ ADRs can be mild to life-threatening, and may occur immediately or later.

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🎯 TYPES OF ADVERSE DRUG REACTIONS (ABCD Classification)

🔠 Type	📖 Description	💡 Example
🅰️ Type A (Augmented)	Predictable, dose-related	Hypoglycemia from insulin
🅱️ Type B (Bizarre)	Unpredictable, allergic/idiosyncratic	Penicillin allergy
🅲️ Type C (Chronic)	Long-term use effects	Steroid-induced diabetes
🅳️ Type D (Delayed)	Appears after prolonged use	Cancer from chemotherapy
🅴️ Type E (End of use)	Withdrawal symptoms	Seizures after stopping antiepileptics

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🚨 COMMON ADR EXAMPLES

💊 Drug	⚠️ ADR
Aspirin	GI bleeding, tinnitus
ACE Inhibitors (Enalapril)	Cough, angioedema
Aminoglycosides (Gentamicin)	Nephrotoxicity, ototoxicity
Warfarin	Bleeding
Phenytoin	Gum hypertrophy, ataxia
Insulin	Hypoglycemia

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👩‍⚕️ NURSE’S ROLE IN ADRs

✅ Monitor for early signs of adverse reactions
✅ Check allergy history before giving drugs
✅ Educate patients about possible side effects
✅ Document & report ADRs using pharmacovigilance forms
✅ Support emergency care if serious reactions occur

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🌟 DRUG INTERACTIONS 🌟

🔁 “Some drugs don’t mix well — interactions can be dangerous.”

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📘 DEFINITION

🗨️ A Drug Interaction occurs when two or more drugs react with each other, altering the effect, absorption, metabolism, or toxicity of one or more drugs.

✅ Can lead to increased toxicity or reduced effectiveness.

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🔬 TYPES OF DRUG INTERACTIONS

🔹 1️⃣ Drug–Drug Interactions

E.g., Aspirin + Warfarin → 🔥 ↑ Bleeding risk

🔹 2️⃣ Drug–Food Interactions

E.g., MAO inhibitors + Cheese → 🔼 Hypertension
E.g., Grapefruit juice + Statins → 💥 Toxicity

🔹 3️⃣ Drug–Disease Interactions

E.g., NSAIDs in kidney disease → 💥 Worsened renal function

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🧠 COMMON DANGEROUS DRUG COMBINATIONS

💊 Combination	⚠️ Effect
Digoxin + Diuretics	Hypokalemia → digoxin toxicity
Warfarin + Antibiotics	↑ INR → bleeding risk
MAOIs + Tyramine-rich food	Hypertensive crisis
Theophylline + Ciprofloxacin	Toxic theophylline levels
Calcium + Tetracycline	↓ Tetracycline absorption

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👩‍⚕️ NURSE’S ROLE IN DRUG INTERACTIONS

🔹 Review current medications and allergies
🔹 Check for known interactions using a drug guide
🔹 Instruct patients on timing and food restrictions
🔹 Monitor for unexpected effects or toxicity
🔹 Report and document any adverse outcomes

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📌 MOST ASKED EXAM QUESTIONS (MCQ STYLE)

✅ Q: What is a Type A adverse drug reaction?
🅰️ Dose-dependent and predictable (e.g., hypoglycemia from insulin)

✅ Q: What happens when warfarin is combined with aspirin?
🅰️ Increased risk of bleeding

✅ Q: Which food should be avoided with MAO inhibitors?
🅰️ Cheese (contains tyramine)

✅ Q: What is the nurse’s first action after observing an ADR?
🅰️ Stop the drug and notify the physician

✅ Q: Drug interaction between digoxin and furosemide may cause…?
🅰️ Digoxin toxicity due to hypokalemia

🌟 10 RIGHTS OF DRUG ADMINISTRATION 🌟

🩺 “Safe medication = Right decision at the right moment.”
✅ These 10 rights ensure safe, effective, and error-free medication delivery in nursing and healthcare practice.

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✅ 1️⃣ RIGHT PATIENT 👤

🔍 Ensure the correct identity of the patient.
🔹 Use two identifiers: Name + ID number / Date of Birth
🔹 Always verify with ID band or case sheet
🔸 Ask: “Can you tell me your full name?”

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✅ 2️⃣ RIGHT MEDICATION 💊

🧾 Administer the correct drug as prescribed.
🔹 Cross-check prescription, drug label, and med chart
🔹 Be alert for look-alike/sound-alike medications
🔹 Do not give any unlabeled drug

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✅ 3️⃣ RIGHT DOSE 📏

⚖️ Give the exact amount prescribed.
🔹 Double-check units (mg, mL, IU)
🔹 Use drug calculation formulas if needed
🔹 Ask pharmacist if dose seems too high/low

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✅ 4️⃣ RIGHT ROUTE 🚨

🩹 Administer through the correct route:
🔹 PO (oral), IV, IM, SC, SL, Topical, PR, etc.
🔸 Never substitute route without doctor’s advice

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✅ 5️⃣ RIGHT TIME ⏰

🕒 Give medication at the correct time.
🔹 Follow frequency (e.g., BD, TDS, QID)
🔹 Maintain 1-hour window unless stated otherwise
🔹 Watch for time-critical drugs like insulin, antibiotics

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✅ 6️⃣ RIGHT DOCUMENTATION 📝

🖊️ Record after giving the medication.
🔹 Note time, date, dose, route
🔹 Sign with initials
🔹 Mention any refusal, reaction, or delay

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✅ 7️⃣ RIGHT REASON 🎯

🧠 Know why you’re giving the drug.
🔹 Understand indication and patient’s condition
🔹 Check lab values or vital signs if needed
🔸 E.g., Check BP before giving antihypertensive

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✅ 8️⃣ RIGHT RESPONSE ✅

🩺 Monitor for desired effect or side effects.
🔹 Assess patient’s pain relief, fever control, BP
🔹 Report unexpected reactions immediately

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✅ 9️⃣ RIGHT TO REFUSE 🙅

🧍‍♂️ Patients have the right to say no.
🔹 Respect refusal
🔹 Educate about risks/benefits
🔹 Document refusal and inform the doctor

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✅ 🔟 RIGHT EDUCATION 📚

👩‍🏫 Inform the patient about the medicine being given.
🔹 Name, purpose, how to take, side effects
🔹 Encourage questions
🔹 Promotes adherence and trust

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🧠 NURSE’S RESPONSIBILITY

🔹 Follow all 10 rights diligently
🔹 Avoid shortcuts or assumptions
🔹 Always verify prescription
🔹 Keep updated knowledge on new drugs
🔹 Practice error reporting and safe handling

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📌 MOST ASKED EXAM QUESTIONS (MCQ STYLE)

✅ Q: How many “Rights” of drug administration are there?
🅰️ 10

✅ Q: What is the ‘Right Patient’ verification method?
🅰️ Use name and ID band

✅ Q: Which ‘Right’ involves checking BP before antihypertensive drug?
🅰️ Right Reason

✅ Q: What does ‘Right Time’ mean in medication administration?
🅰️ Giving the drug at the correct scheduled time

✅ Q: If a patient refuses medication, which ‘Right’ does it involve?
🅰️ Right to Refuse

🌟 DRUG DOSAGE CALCULATIONS 🌟

📏 “Calculate with care — protect with precision.”

Knowing how to calculate drug dosages accurately is essential for safe medication administration and error prevention in nursing.

📘 BASIC FORMULA FOR DOSAGE CALCULATION

🧮 Use the universal D/H × Q formula:

📐 D = Desired dose (doctor’s order)
📐 H = Have (what’s on hand or available)
📐 Q = Quantity (form in which drug is available – tab, mL, amp)

🧪 Formula:

✅ Dose to Administer = 𝐃 ÷ 𝐇 × 𝐐

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🧮 EXAMPLE 1 – TABLET FORM

Order: Give 500 mg of paracetamol
Available: 250 mg per tablet

👉 Dose = (500 ÷ 250) × 1 = 2 tablets

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🧪 EXAMPLE 2 – LIQUID FORM

Order: Give 125 mg of syrup
Available: 250 mg/5 mL

👉 Dose = (125 ÷ 250) × 5 = 2.5 mL

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💉 INJECTION CALCULATION

Order: Inj. Ampicillin 750 mg IM
Available: Vial with 1g (1000 mg) in 2 mL

👉 Dose = (750 ÷ 1000) × 2 = 1.5 mL

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⏱️ IV INFUSION RATE FORMULA

🧮 Formula:

✅ Drops per minute = (Volume × Drop factor) ÷ Time (in minutes)

Drop factor:

• 15 drops/mL (macro set)
• 60 drops/mL (micro set)

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💧 EXAMPLE:

Order: 1000 mL NS over 8 hours using macro drip (15 gtt/mL)

👉 Rate = (1000 × 15) ÷ 480 = 31.25 ≈ 31 drops/min

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💊 BODY WEIGHT-BASED DOSAGE

🧮 Formula:

✅ Dose = Weight (kg) × Dose per kg

Example:
Order: 10 mg/kg of drug
Patient weight: 20 kg
👉 Dose = 10 × 20 = 200 mg

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🧠 CONVERSION FACTORS TO REMEMBER

🔁 Unit	🔄 Conversion
1 g	1000 mg
1 mg	1000 mcg
1 kg	1000 g
1 L	1000 mL
1 tsp	5 mL
1 tbsp	15 mL
1 oz	30 mL
1 cup	240 mL

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⚠️ NURSE’S RESPONSIBILITIES

👩‍⚕️ Always: 🔹 Verify doctor’s order
🔹 Double-check calculations
🔹 Clarify unusual dosages
🔹 Use correct measuring tools (syringe, cup, spoon)
🔹 Monitor 10 Rights of Drug Administration
🔹 Document immediately after administration

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📌 MOST ASKED EXAM QUESTIONS (MCQ STYLE)

✅ Q: What is the formula for calculating drug dosage?
🅰️ D ÷ H × Q

✅ Q: What is the drop rate for 1000 mL over 8 hrs at 15 gtt/mL?
🅰️ 31 drops/min

✅ Q: How many mg in 2 g?
🅰️ 2000 mg

✅ Q: Doctor orders 200 mg; you have 100 mg/mL. How much will you give?
🅰️ 2 mL

✅ Q: How many mL are in 1 tablespoon?
🅰️ 15 mL

🌟 IV FLOW RATE PRACTICE 🌟

💉 “Set the rate right — because every drop counts!”

IV flow rate calculations help nurses determine how fast IV fluids should be infused based on the volume and duration prescribed.

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📘 BASIC FORMULA (For Manual Drip Set)

🧮 Flow Rate (gtt/min) =

👉 (Volume to be infused in mL × Drop factor) ÷ Time in minutes

📌 Term	🔍 Meaning
Volume	Total fluid to be infused (in mL)
Drop Factor	gtt/mL (from IV set: 10, 15, 20 = macro; 60 = micro)
Time	Total infusion time in minutes

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🧪 EXAMPLE 1 – MACRODRIP

Order: Infuse 1000 mL over 8 hours using a 15 gtt/mL set.

🧮
→ Time = 8 hours × 60 = 480 minutes
→ Flow rate = (1000 × 15) ÷ 480 = 31.25 ≈ 31 drops/min

✅ Answer: Set IV at 31 gtt/min

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🧪 EXAMPLE 2 – MICRODRIP

Order: Infuse 500 mL over 5 hours using a 60 gtt/mL set.

🧮
→ Time = 5 × 60 = 300 min
→ Flow rate = (500 × 60) ÷ 300 = 100 gtt/min

✅ Answer: Set IV at 100 drops/min

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🧪 EXAMPLE 3 – SHORT INFUSION

Order: Infuse 250 mL NS over 2 hours using a 20 gtt/mL set.

🧮
→ Time = 2 × 60 = 120 minutes
→ Flow rate = (250 × 20) ÷ 120 = 41.66 ≈ 42 gtt/min

✅ Answer: Set IV at 42 drops/min

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📘 FORMULA FOR IV INFUSION USING INFUSION PUMP

🧮 Flow Rate (mL/hr) =

👉 Total volume (mL) ÷ Time (hr)

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🧪 EXAMPLE 4 – INFUSION PUMP

Order: 1500 mL over 12 hours

🧮 Flow rate = 1500 ÷ 12 = 125 mL/hr

✅ Answer: Set infusion pump to 125 mL/hr

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🎯 PRACTICE QUESTIONS (MCQ STYLE)

✅ Q1: Infuse 1000 mL over 6 hours using 15 gtt/mL. What is the flow rate?

🅰️ (1000 × 15) ÷ 360 = 41.6 ≈ 42 gtt/min

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✅ Q2: Doctor orders 500 mL Dextrose over 4 hours using 20 gtt/mL. What’s the flow rate?

🅰️ (500 × 20) ÷ 240 = 41.6 ≈ 42 drops/min

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✅ Q3: Using a microdrip (60 gtt/mL), infuse 100 mL over 30 minutes. What is the rate?

🅰️ (100 × 60) ÷ 30 = 200 gtt/min

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✅ Q4: What is the infusion pump rate for 750 mL over 10 hours?

🅰️ 750 ÷ 10 = 75 mL/hr

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⚠️ SAFETY TIPS FOR IV INFUSION

🔹 Use infusion pump for high-alert drugs
🔹 Monitor site for infiltration or phlebitis
🔹 Adjust rate without sudden changes
🔹 Label IV lines and document flow rate
🔹 Follow 10 rights of medication administration

🌟 DOSAGE CALCULATION PRACTICE QUESTIONS 🌟

📏 “Practice makes perfect — precision saves lives.”

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✅ BASIC FORMULA TO REMEMBER

📐 Dose to Give = (Desired Dose ÷ Dose on Hand) × Quantity Available

👉 𝐃 ÷ 𝐇 × 𝐐

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🧪 Q1:

Doctor’s Order: 500 mg of Paracetamol
Available: 250 mg per tablet
👉 How many tablets will you give?

✅ Answer:
(500 ÷ 250) × 1 = 2 tablets

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🧪 Q2:

Doctor’s Order: 125 mg of syrup
Available: 250 mg/5 mL
👉 How many mL will you administer?

✅ Answer:
(125 ÷ 250) × 5 = 2.5 mL

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🧪 Q3:

Order: Inj. Ceftriaxone 750 mg IM
Available: 1 g (1000 mg) in 2 mL
👉 How much to inject?

✅ Answer:
(750 ÷ 1000) × 2 = 1.5 mL

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🧪 Q4:

Order: 10 mg/kg of medication
Patient weight: 25 kg
👉 What is the total dose in mg?

✅ Answer:
10 × 25 = 250 mg

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🧪 Q5:

Order: Give 0.3 g of a drug
Available: 100 mg/mL
👉 How many mL to administer?

✅ Convert 0.3 g to mg: 0.3 × 1000 = 300 mg
👉 (300 ÷ 100) = 3 mL

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🧪 Q6:

Doctor orders: 2 tablets of 500 mg each
Available: 250 mg tablets
👉 How many tablets to give?

✅ Answer:
1000 ÷ 250 = 4 tablets

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🧪 Q7:

Order: 20 mL of drug over 30 minutes
Drop Factor: 15 gtt/mL
👉 How many drops per minute?

✅ (20 × 15) ÷ 30 = 10 drops/min

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🧪 Q8:

IV Order: Infuse 1000 mL over 8 hours using 20 gtt/mL set
👉 What’s the flow rate in gtt/min?

✅ 8 hrs = 480 mins
(1000 × 20) ÷ 480 = 41.6 ≈ 42 drops/min

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🧪 Q9:

Doctor orders: 75 mg of drug
Available: 25 mg per 2 mL
👉 How many mL will you administer?

✅ (75 ÷ 25) × 2 = 6 mL

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🧪 Q10:

Order: 1.5 g medication
Available: 500 mg/mL
👉 How many mL to give?

✅ Convert 1.5 g to mg: 1500 mg
1500 ÷ 500 = 3 mL

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🧠 KEY CONVERSIONS TO REMEMBER

🔁 Unit	Conversion
1 g =	1000 mg
1 mg =	1000 mcg
1 L =	1000 mL
1 tsp =	5 mL
1 tbsp =	15 mL

🌟 PEDIATRIC DOSAGE CALCULATIONS 🌟

👶 “In pediatrics, even a drop matters — calculate with care.”

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📘 FORMULAS FOR PEDIATRIC DOSING

✅ 1️⃣ Clark’s Rule (by weight in pounds)

📐 Dose = (Weight in lb ÷ 150) × Adult dose

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✅ 2️⃣ Young’s Rule (by age in years)

📐 Dose = (Age ÷ [Age + 12]) × Adult dose

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✅ 3️⃣ Fried’s Rule (for infants under 1 year)

📐 Dose = (Age in months ÷ 150) × Adult dose

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✅ 4️⃣ Body Weight Method (Most Common)

📐 Dose = Weight in kg × Drug dose per kg

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🧪 EXAMPLE 1: Weight-Based Calculation

Order: Paracetamol 15 mg/kg
Child’s weight: 12 kg
👉 Dose = 15 × 12 = 180 mg

✅ If syrup strength = 250 mg/5 mL
📐 (180 ÷ 250) × 5 = 3.6 mL

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🧪 EXAMPLE 2: Using Clark’s Rule

Order: Adult dose = 500 mg
Child’s weight = 33 lb
👉 Dose = (33 ÷ 150) × 500 = 110 mg

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⚠️ NURSE’S TIPS IN PEDIATRIC DOSING

👩‍⚕️
🔹 Always use weight in kg
🔹 Use oral syringes for liquid meds
🔹 Monitor for toxicity signs
🔹 Double-check math and units
🔹 Consult pharmacy if unsure

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🌟 INSULIN CALCULATIONS 🌟

💉 “Balance the sugar — calculate the dose.”

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📘 TYPES OF INSULIN

💉 Type	⏱️ Onset	⏱️ Peak	⌛ Duration
Rapid-acting	10–15 min	1 hr	3–5 hrs
Short-acting	30–60 min	2–4 hrs	5–8 hrs
Intermediate (NPH)	1–3 hrs	5–7 hrs	12–16 hrs
Long-acting (Glargine)	1 hr	No peak	24 hrs

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💉 COMMON INSULIN FORMULAS

✅ Sliding Scale Insulin

Prescribed based on blood glucose readings

Glucose (mg/dL)	Insulin Units
150–200	2 units
201–250	4 units
251–300	6 units
301–350	8 units
>350	Call physician

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🧪 EXAMPLE: Sliding Scale Dose

BG = 278 mg/dL
👉 Give 6 units of Regular insulin subcutaneously

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💉 MIXING INSULINS (Clear to Cloudy Rule)

✔️ Always draw Regular (clear) insulin first
✔️ Then draw NPH (cloudy) insulin
👉 “Clear before Cloudy”

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📏 INSULIN SYRINGE MARKINGS

🔢 Syringe Type	📍 Markings
U-100	100 units/mL
U-40	40 units/mL

✅ 1 mL U-100 insulin = 100 units

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⚠️ NURSE’S ROLE IN INSULIN ADMINISTRATION

👩‍⚕️
🔹 Double-check insulin type and dose
🔹 Use insulin-specific syringe
🔹 Rotate injection sites
🔹 Monitor blood sugar before/after
🔹 Never shake insulin — roll if needed
🔹 Be alert for hypoglycemia signs: cold sweat, tremors, confusion

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📌 MOST ASKED EXAM QUESTIONS (MCQ STYLE)

✅ Q: What is the pediatric dose of paracetamol?
🅰️ 15 mg/kg/dose

✅ Q: Which insulin is drawn up first when mixing insulins?
🅰️ Regular insulin (clear)

✅ Q: What is the rule for infants’ dosing called?
🅰️ Fried’s Rule

✅ Q: What is the onset time of rapid-acting insulin?
🅰️ 10–15 minutes

✅ Q: How many units are in 0.5 mL of U-100 insulin?
🅰️ 50 units