1. CLINICAL
PHARMACOLOG
Y
ARPIT PARTIL

2. INTRODUCTION
◦ The science of drugs is known as pharmacology.
◦ Pharmacology word derived from Greek language;
pharmakon means drug or poison and Logos means discourse.
◦ Pharmacology deals with the interaction of any substance or chemical
molecule which is administered exogenously into the living system and
which can produce a significant biological response in the body. It
comprises all the aspects related to the drug knowledge but also deals
with the effectiveness and safer use of the drug.
◦ Jonathan Pereira is a Father of pharmacology.

3. DEFINITION OF MEDICATION
◦ A drug is any substance that alters the physiological and biological
functions with the potential for affecting an individual's health
OR
◦ Medication is a drug that is administered for its therapeutic effects on
the body.
◦ Drugs are administrated into the body in many ways.

4. PURPOSES OF MEDICATION
◦ Diagnostic purpose :- certain medications and drugs are used to identify the diseases.
Like radiocontrast dye and tuberculosis testing.
◦ Prophylaxis :- medications can be used to prevent the occurrence of disease. Like
heparin is used for the prevention of thrombosis and antibiotics are used for infection
prevention.
◦ Therapeutic purpose :- used for the cure of disease. Purposes of Drug Administration
to treat or cure disease/symptoms experienced to diagnose the disease, for example,
dyes like barium are administered intravenous or orally for radiological examinations.

5. PURPOSES OF DRUG ADMINISTRATION
◦ To prevent diseases :- for example, vaccines are administered to
prevent the occurrence of disease.
◦ To promote health and wellness :- Medications like multivitamins are
administered for immunity boost or to promote wellness.
◦ To diagnose and cure or treat the disease.

6. PRINCIPLES OF MEDICATION
ADMINISTRATION
◦ Talk with the patient and explain the action and purpose of medication to administer.
◦ Help the individual to be as involved as possible in the process of medication
administration.
◦ Provide privacy for the individual.
◦ Give medications in a quiet area, free from distractions.
◦ Never leave medications unattended, even for a moment.
◦ Wash hands before and after giving the medication.

7. RIGHTS OF MEDICATION
◦ Right patient: Ask the name of the patient and check his/her ID band before giving the
medication.
◦ Right drug: The first right of drug administration is to check and verify if it's the right
name and form. Beware of look-a-like and sound-a-like medication names. Misreading
medication names that look similar is a common mistake.
◦ Right dose: Check the medication sheet and the doctor’s order before giving the
medication. Be aware of the difference between an adult and a pediatric dose.
◦ Right route: Check the order if it's oral, IV, SQ, IM, etc.
◦ Right time and frequency: Check the order for when it wouldbe given and when was
the last time it was given.

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◦ Right documentation: Sign, date all documentation recording the administration of the
medicine in medication chart.
◦ Right History and assessment: Secure a copy of the client’s history of drug interactions
and allergies.
◦ Right to refuse: Give the patient enough autonomy to refuse the medication after
thoroughly explaining the effects.
◦ Right drug-drug interaction and evaluation: Review the medications previously given or the
diet of the patient that can interact with the drug to be given. Also check the expiry date of
the medication being given.
◦ Right education and information: Provide enough knowledge to the patient of what drug
he/she would be taking and what are the expected therapeutic and side effects.

9. MEDICATION ORDER
◦ Medication orders are written or computer generated by the prescriber for a specific
medication that is to be administered to the patient. Nurses need to be aware while
following the order. Five common types of medication orders are;
1. Standing order :- A standing order is a written instruction issued by the prescriber. In
this, medication has to be given for a certain number of doses or for the certain period
of time or days.
2. Prn order :- The prn medications are given on an as needed basis for any specific signs
and symptoms. In this, the prescriber assess and gather the subjective as well as
objective data of the patient, to determine whether the patient needs medication or not.
3. Single order :- A health care worker will often order a medication to be given only once
at specified time. This order is usually used for preoperative medication or any
diagnostic procedure.

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4. STAT order :- A STAT order defines that a single dose of medication is to be given
immediately and only once. These orders are mainly used in emergencies when the
patient's condition changes suddenly.
5. Now order :- A now order is more specific than a onetime order and is used when
patient needs medication quickly but not right away, as in the STAT order. After
receiving the now order, nurse has 90 minutes to administer the medication.

11. PRESCRIPTION
◦ The prescriber writes prescriptions for the patients who have to take medications from
outside the hospital.
◦ The prescription includes:
◦ The full detailed information of the patient than are gular order.
◦ It should be clear and written in simple manner.
◦ No use of abbreviation or short terms.

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◦ Prescription's Components
◦ Date and time of prescription.
◦ Information of the prescriber and the patient.
◦ Main medication name (generic or trade).
◦ Quantity and dosage of medication Frequency of dosage and time Signature of
the prescriber.
◦ Any special instruction regarding the medication.

13. SAFETY IN ADMINISTERING
MEDICATION
◦ Make the patient priority whenever the medication error occurs.
◦ In case of doubt with any medication, always ask the prescriber.
◦ Follow the rights of medication administration.
◦ Read the labels of medication three times before, during and after the medication
administration.
◦ Prepare the medication in a well lighted area.
◦ Always check the expiry date of the medication.
◦ Do not accept any kind of verbal order or incomplete orders.
◦ Be careful in dose calculation even if it is in a small amount.
◦ Check the patient history for any kind of drug interactions.
◦ Document all the medication as soon as they are given to the patient.

14. MEDICATION ERROR
◦ The medication error defines as any error in prescribing, dispensing or administration
of the drug that can cause harm to the patient. In simple terms, errors are the
mistakes that we do in clinical setting while doing patient care.
OR
◦ Any preventable event that may cause or lead to inappropriate medication use or
patient harm while the medication is in control of the health care professional, patient
or consumer.

15. FACTORS CONTRIBUTING TO
MEDICATION ERROR
1. Human related factors
Providers Patients
◦ Over worked In a hurry
◦ Under trained Health literacy level
◦ Competence Do not understand the medication
◦ Distracted Trust providers to not make-
◦ Illness mistakes
◦ Stressed

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2. System related factors
◦ Lack of communication.
◦ Poor workflow.
◦ Disorganized workplace.
◦ Inadequate tools to complete work.
◦ Lack of supervision.
3. Medication related factors
◦ Look alike/ sound alike medication.
◦ Multiple dosage forms and strength.

17. Medication
errors
Prescription
error
Dispensing
error
Administration
error

18. TYPES OF MEDICATION ERROR
1. Prescription errors: These may be defined as the incorrect drug selection for a
patient. Lack of knowledge of the prescribed drug, its recommended dose, and of
patient details contribute to prescribing errors.
◦ Other contributing factors include:
◦ Illegible handwriting
◦ Inaccurate medication history taking
◦ Confusion with the drug name
◦ Inappropriate use of decimal points
◦ Use out of list abbreviation
◦ Sometimes use of verbal orders

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2. Dispensing errors: These can occur at any stage of the dispensing process, from
the receipt of the prescription in the pharmacy to the supply of a dispensed
medicine to the patient.
It also includes:
◦ Dispensing of wrong medicine, wrong dose and to wrong patient.
◦ Dosage miscalculations
For example, the drugs that have a similar name or appearance, Lasix (furosemide)
and Losec (omeprazole).

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3. Administration errors: These occur when a discrepancy occurs between the drug
received by the patient and the drug therapy intended by the prescriber. Sometimes
incorrect administering techniques lead to fatal effects in the patient.
Contributing factors of administration errors are:
Failure to check the patient identity prior to administration.
Environmental factors such as noise, poor lighting etc.
Wrong calculation of dose.
Wrong site chosen for large volume of drug.

23. DRUG FORMS
◦ Gaseous Dosage Forms
◦ It includes the inhalational/volatile anesthetics which are given before the induction of the
surgery.
◦ Liquid Dosage Forms
◦ Solutions: Prepared by dissolving one or more solute in the solvent to form one homogenous
phase and it should never be mixed. There are different types of solutions like Elixirs, Syrups,
and Tinctures.
◦ Emulsions: These are the dispersion that consists of two immiscible liquids and mostly it has
cloudy appearance.
◦ Suspension: Solid particles are dispersed into the liquid form and these are not used for
systemic administration of drugs.

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◦ Semisolid Dosage Forms
◦ These forms of drugs are unshaped or without any physical shape.
◦ Gels: These are in semisolid form and are composed of 3D cross linked matrix and have
jelly like material.
◦ Creams: These are semisolid emulsions that contain more water.
◦ Ointments: These are mixture of oil and water where the main ingredient is oil.
◦ Suppositories: They are of many shapes and act by melting or dissolving at body
temperature. These are inserted through many routes which include rectal, vaginal, urethral.
Pessaries are form of vaginal suppositories and are of globular, oviform or cone shaped.

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◦ Solid Dosage Forms
◦ The unshaped solid dosage forms include powders for external use.
◦ Shaped solid dosage forms include:
◦ Tablets: These contain dried powdered active drugs and are of different types like sustained
release, controlled release, chewable tablets.
◦ Capsules: These come in two varieties and are easier to swallow. These are formed in one
piece in which the drug is in liquid form inside the soft shell.
◦ Trans-dermal patches: These consist of multi layered disk of drug reservoir and have
porous membrane that sticks to the skin.

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◦ Parenteral drugs
◦ Drugs are administered with a syringe puncturing the body.
◦ Intravenously into the vein (I/V)
◦ Intramuscular injection into muscles (I/M)
◦ Subcutaneous into subcutaneous/fat tissues (S/C)
◦ Intradermal injection into the intradermal space (I/D)

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◦ Topical drugs
◦ These drugs are applied directly to the surface of skin or mucus membrane.
◦ It includes ointments, creams, gels, paste and lotions.
◦ Ophthalmic administration
◦ Administering the medications into the eye.
◦ It includes eye drops and eye ointments.
◦ Otic administration
◦ Administering the medication into ear.

28. ROUTE OF ADMINISTRATION
◦ A route of administration is the path by which a drug, fluid, poison or others substance
is brought into contact with the body.
-Mosby Dictionary of Complementary and Alternative Medicine, 2005

29. ROUTES OF ADMINISTRATION
SYSTEMIC
Enteral
Parenteral
Eg,
Intravenous
Intramuscular
Subcutaneous
Intraarterial
Intrathecal
intradermal
Eg,
Oral
Rectal

30. ROUTE OF ADMINISTRATION
LOCAL
Eg
Topical
Intranasal
Inhalation
Transdermal

31. STORAGE AND MAINTENANCE
◦ The drugs are to be stored as per the prescribed conditions of their storage.
◦ There should not be any damage due to high temperature or exposure to sunlight.
◦ It must be ensured that the stored drugs remain preserved during their storage.
◦ The drugs are stocked in containers, such as boxes and on flexible racks and shelves
etc.
◦ The drugs that are supplied to the ward are stored in drug cupboards to provide a
uniform supply of drugs to the patients.

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◦ PROPER DRUG STORAGE
◦ Drugs are stored in a specially designed secure area or space.
◦ Avoid contamination or deterioration.
◦ Avoid disfiguration of labels.
◦ Maintain integrity of packaging and so guarantee quality and potency of drugs during
shelf life.
◦ Prevent or reduce pilferage, theft or losses.
◦ Prevent infestation of pests and rodents.

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◦ The STORAGE ENVIRONMENT should possess the following:
◦ Adequate temperature,
◦ Sufficient lighting,
◦ Clean conditions,
◦ Humidity control,
◦ Cold storage facilities,
◦ Clean floor and free from dirt and water,
◦ Adequate shelving to ensure integrity of the stored drugs.

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◦ ARRANGEMENT OF DRUGS ON SHELVES
◦ Shelves should be strong.
◦ Shelves should be made of steel or wood.
◦ Each dosage from the same drug is arranged in a separate area.
◦ Drugs should be arranged in alphabetical order of generic names so that they can be
easily traced.
◦ Most recently received drugs are placed behind old stock on the shelf except where new
drugs have shorter expiration dates.
◦ Store liquid drugs in lower shelf.
◦ Store must be clean daily.

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◦ Single-use devices are meant for single use only and must not be re-used.
◦ The area used for storage of IV fluids should have adequate space and to prevent
exposure to direct sunlight.
◦ All medical equipment, dressings and solutions used during invasive procedures must be
sterile.
◦ Medications must not be administered, and products and equipment must not be used
beyond their expiry dates.
◦ Store medications that are ‘for external use only’ separate from the medications that are
‘for internal use’.
◦ The keys should be available only to authorized personnel who are assigned medication-
related responsibilities.

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◦ Record in the form of CONTROLLED DRUG REGISTERS must be kept.
◦ Each drug must have its own specified page which is Headed with the Drugs name
and Strength.
◦ The Number of Ampoules of a drug must be entered and updated with every use and
in each shift.
◦ Must record Date, Time, Dose of every administration, Name of receiving
patient/client, Number of ampoules at start and finish of administration.
◦ LASA DRUGS
◦ FIFO/FEFO

37. STORAGE OF NARCOTIC DRUGS
◦ The narcotic drugs should be stored under different cupboard with double lock and
key
◦ The key of the lock should be with two different people
◦ No other drug should be kept in the cupboard where narcotic drugs are stored.
◦ The access should be with a particular person like sister in charge in the ward.
◦ The narcotic drugs register must incorporate a of all receipt and issue of narcotic
drugs.
◦ Pharmacist shall be notified if any medicines or register is missing.