Los Angeles Harbor College Division of Nursing

Transcription

1 Los Angeles Harbor College Division of Nursing Nursing Pharmacology N364 Section Spring 2014 Course Syllabus Instructor: Staff

2 Course Title: Nursing 364 Pharmacology Faculty Contact Information: Office Hours: Start Date: 02/13/2014 End Date: 05/29/2014 Classroom: NU 153 Time: Thursday Catalog Description: This course is open to pre-nursing majors, nursing students and those interested in developing an understanding of medications. This course provides an understanding of basic pharmacology and the standards, policies, and regulations involved in mediation administration. A brief review of the math concepts involved in the calculations of dosages is included. The course focus is on drugs classifications, pharmacodynamics, chemical interactions, toxicology and the use of the nursing process in medication administration. Credit/Contact Hours: 3 Units Transferability: Conditional Prerequisites: Admission to LAHC and appropriate registration and payment of fees. Required Textbooks and Supplies: Adams, M.P. & Holland, L.N. (2014). Pharmacology for nurses: A pathophysiologic approach (4th Ed.). Pearson. ISBN: Recommended Textbook: Deglin, J.H., Vallerand, A.H., & Sanoski, C. A. (2011). Davis s drug guide for nurses (12 th Ed.). F.A. Davis Company. Scantrons: Will be required for quizzes and the final exam. Attendance Policy: Class absences are not to exceed one class lecture. If the student is ill or has an emergency, please contact instructor for the week as soon as possible. Students are urged not to be absent, and are reminded that the student is responsible for all information given during class time. Three tardies will be counted as one absence. Absence that exceeds specified maximum may result in exclusion from the course or receiving an F grade. Students who know that there is a strong possibility that they will miss more than one class should not take the course.

3 Course Credit Challenging Policy: Not applicable. College and Department Policies: See College Catalog. Board Policies and Accommodations: 1. Students requiring special accommodations in a course must present official documentation of the type of accommodations required to the nursing faculty. 2. Board Rule Dishonesty, such as cheating, or knowingly furnishing false information to the college. Examples of academic dishonesty: A student copies from another student, to help an academically weaker student by providing answers to a test or using crib notes. 3. Board Rule Obstruction or disruption of classes, administration, disciplinary procedures, or authorized college activities. 4. Board Rule Alcohol and Drugs. Any possession of controlled substances which would constitute a violation of Health and Safety Code Section or Business and Professional Code section 4230, any use of controlled substance, the possession of which are prohibited by the same, or any possession or use of alcoholic beverages. *Please see college catalog for a listing of all District Board Rules. Also, refer to the Student Discipline Procedure for due process for disciplinary issues, grievances, and the student appeal process. Course Grading: This course has 200 points. There are 12 quizzes worth 10 points each. The lowest quiz grade will be dropped, resulting in 110 possible quiz points. A 30 point drug group presentation will be required. There will be a 60 point comprehensive final exam. There are no scheduled make-up quizzes and group presentation. Students are urged to contact the instructor if major illness occurs resulting in missing quizzes and/or the final exam. The grade obtainable for the final taken after the scheduled testing day is 75%. Make-up finals may be multiple choices, fill-in, essay, or a combination of all of the above. To receive a grade of W (withdrawal) for the class, the student must officially drop the course in admissions by the date published in the class schedule. There will be no extra credit assignments offered. There will be no grade of Incomplete given for the class. Drug Presentation: See Appendix A for further details. Grading Scale: A (90% - 100%)

4 B (81% - 89%) C (75% - 80%) D (60% - 74%) F (Less than 60%) Learning Resources: College Library, Nursing Learning Lab (over night check-out not allowed), and Learning Resource Center in College Library. Method of Instruction: Lecture, Discussion, Related Readings, Presentations, and Internet. Evaluation Method: Objective quizzes, comprehensive final exam, and drug card presentation. Study Time: The College expects a minimum of two hours of study/preparation by the student for each hour of lecture. Plagiarism: Any form of academic dishonesty is not tolerated within the Los Angeles Community College District and will result in a zero for the assignment in question and in most cases will result in a fail for the course. Any student with subsequent incident of plagiarism will be referred to the Vice President of Student Services and may be expelled from the college. Please refer to the College Catalog for further information. Schedule of Assignments: Date Content Chapters Assignments Week 1 02/13/2014 Introduction to Course Review Syllabus & Textbook Introduction to Pharmacology: Drug Regulation and Approval Pharmacokinetics & Pharmacodynamics 1, 4, 5 Week 2 02/20/2014 Drug Classes and Schedules Nursing Process in Pharmacology 2 6 Week 3 02/27/2014 Principles of Drug Administration Medication Errors and Risk Reduction Drug Dosages and Calculation 3, 7, Appendix B Quiz #1 (2,4, 5)

5 Week 4 03/06/2014 Week 5 03/13/2014 Week 6 03/20/2014 Week 7 03/27/2014 Week 8 04/03/2014 Week 9 04/10/2014 Week 10 04/17/2014 Drugs for Seizures Drugs for Emotional and Mood Disorders Drugs for Psychoses Substance Abuse Drugs for Anxiety and Insomnia Drugs for Control of Pain Drugs for Coagulation Disorders Drugs for Hematopoietic Disorders Hypertension Heart Failure Angina Pectoris and Myocardial Infarction Drugs for Asthma and Other Pulmonary Disorders Drugs for Bacterial Infections & Viral Infections Drugs for Neuromuscular Disorders Drugs for Bone and Joint Disorders SPRING BREAK 15, 16, 17 11, 14, 18 Quiz #2 (3, 6, 7, Dosage & Calculations) Quiz # 3 (15, 16, 17) Group 1 - Lorazepam (Ativan) Group 2 Morphine (Duramorph) 30, 31 Quiz #4 (11, 14, 18) Group 3 Heparin Group 4 Warfarin (Coumadin) 25, 26, 27 39, 34, 36 Quiz #5 (30, 31) Group 5 Prinivil (Zestril) Group 6 Nitroglycerin (Nitro-Bid) Quiz #6 (25, 26, 27) Group 7 Albuterol (Proventil) Group 8 Penicillin G 21, 47 Quiz #7 (39, 34, 36)

6 Week 11 04/24/2014 Week 12 05/01/2014 Week 13 05/08/2014 Week 14 05/15/2014 Drugs for Degenerative Diseases of the Nervous system Drugs for Diabetes Mellitus Diuretic Therapy and Drugs for Renal Failures Drugs for Fluid Balance, Electrolytes, and Acid-Base Disorders Drugs for Peptic Ulcers Disease Drugs for Bowel Disorders and other Gastrointestinal Conditions Drugs for Disorders and Conditions of the Female Reproductive System Drugs for Disorders and Conditions of the Male Reproductive System 20, 44 Quiz # 8 (21, 47) Group 9 Cyclobenzaprine (Flexeril) Group 10 Human Regular Insulin (Humulin R, Novolin R) 23, 24 Quiz #9 (20, 44) Group11 Furosemide (Lasix) Group 12 Potassium Chloride (KCL) 40, 41 Quiz # 10 (23, 24) Group 13 Ranitidine (Zantac) Group 14 Psyllium Mucilloid (Metamucil) 45, 46 Quiz # 11(40, 41) Group 15 Oxytocin (Pitocin) Group 16 Sildenafil (Viagra) Week 15 05/22/2014 Week 16 05/29/2014 Drugs for Autonomic Nervous System Drugs for Dysrhythmias Drugs for Shock Last day of class Comprehensive Final 13, 29, 28 Quiz # 12 (45, 46) Group 17 Amiodarone (Cordarone) Group 18 Dopamine (Dopastat) Complete Course Evaluation (Online) FINAL = 25? S ( questions on Final will be on chapters 13, 29, 28)

7 Course Topics & Objectives Week 1 02/13/2014 Week 2 02/20/2014 Week 3 02/27/2014 Introduction to Pharmacology Course 1. Meet class 2. Introduction to Course 3. Review syllabus & textbook Introduction to Pharmacology: Drug Regulation and Approval (Chapter 1) 1. Define Pharmacology 2. Identify the advantages and disadvantages of prescription and overthe-counter drugs 3. Discuss role of the U.S. FDA 4. Explain the four stages of approval for therapeutic and biologic drug Pharmacokinetics (Chapter 4) 1. Define Pharmacokinetics 2. Identify and recall the four components of pharmacokinetics 3. Describe major processes by which drugs are excreted 4. Explain the applications of a drug s plasma half-life and therapeutic range 5. Differentiate between loading and maintenance doses Define and discuss Pharmacodynamics (Chapter 5) 1. Define Pharmacodynamics 2. Compare and contrast the terms potency and efficacy 3. Distinguish between and agonist, a partial agonist, and an antagonist 4. Explain the relationship between receptors and drug action Drug Classes and Schedules (Chapter 2) 1. Explain the basis for placing drugs into therapeutic and pharmacologic classes 2. Discuss the prototype approach to drug classification 3. Describe what is meant by a drug s mechanism of action 4. Explain the meaning of a controlled substance 5. Identify the five drug schedules and give examples of drugs at each level Nursing Process in Pharmacology (Chapter 6) 1. Compare and contrast the different steps of the nursing process: Assessment, Diagnosing, Planning, Implementing, Evaluating Principles of Drug Administration (Chapter 3) 1. Describe the roles and responsibilities of the nurse regarding drug administration 2. State the five rights of drug administration and explain how they affect patient safety 3. Compare and contrast the three systems of measurement used in pharmacology Medication Errors and Risk Reductions (Chapter 7)

8 1. Define medication error and identify factors that contribute to medication errors 2. Describe specific categories of medication errors 3. Explain the impact of medication errors on all aspects of a health care agency 4. Describe strategies that the nurse can implement to reduce medication errors and incidents 5. Identify patient teaching information that can be used to reduce medication errors and incidents Drug Dosages and Calculation (Appendix B) 1. Identify metric units of measurement commonly used in dosage calculation of oral and parenteral medications 2. State common equivalents in the metric system that are used for medication administration 3. Convert metric weights and volume within the metric system 4. Convert body weight from pounds to kilograms 5. Use one of the following methods to accurately calculate medication dosages: D x Q Ration and proportion H Week 4 03/06/2014 Seizures (Chapter 15) 1. Compare and contrast the terms seizures, convulsions, and epilepsy 2. Explain the importance of patient drug compliance in the pharmacotherapy of epilepsy and seizures 3. Describe the nurse s role in the pharmacologic management of seizures of an acute nature and epilepsy 4. Review prototype drugs including actions and uses, administration Phenobarbital (Luminal), Diazepam (Valium), Phenytoin (Dilantin), Valporic Acid (Depakene, Depakote) Emotional and Mood Disorders (Chapter 16) 1. Identify the two major categories of mood disorders and their symptoms 2. Identify symptoms of attention deficit-hyperactivity disorder 3. Discuss the nurse s role in the pharmacologic management of patients with depression, bipolar disorder, or attention deficithyperactivity disorder 4. Review prototype drugs including actions and uses, administration Imipramine (Tofranil), Sertraline (Zoloft), Phenelzine (Nardil), Lithium (Eskalith), Methylphenidate (Ritalin) Psychoses (Chapter 17) 1. Compare and contrast the positive and negative symptoms of schizophrenia

9 Week 5 03/13/2014 Week 6 03/20/ Explain the importance of drug compliance in the pharmacotherapy of schizophrenia 3. Explain the symptoms associated with extrapyramidal side effects of antipsychotic drugs 4. Describe the nurse s role in the pharmacologic management of schizophrenia 5. Review prototype drugs including actions and uses, administration Chlorpromazine, Haloperidol (Haldol), Risperidone (Risperdal) Substance Abuse (Chapter 11) 1. Explain underlying causes of addiction 2. Compare and contrast psychological and physical dependence 3. Compare withdrawal syndromes for the various substance abuse classes 4. Describe the role of the nurse in delivering care to individuals who have substance abuse issues Anxiety and Insomnia (Chapter 14) 1. Identify the major types of anxiety disorders 2. Discuss factors contributing to anxiety and explain some nonpharmacologic therapies used to cope with this disorder 3. Identify three classes of medication used to treat anxiety and sleep disorders 4. Explain the pharmacologic management of anxiety and insomnia 5. Describe the nurse s role utilizing the nursing process in the pharmacologic management of anxiety and insomnia 6. Review prototype drugs including actions and uses, administration Escitalopram Oxalate (Lexapro), Lorazepam (Ativan), Zolpidem (Ambien) Drugs for Control of Pain (Chapter 18) 1. Relate the importance of pain assessment to effective pharmacotherapy 2. Describe the role of nonpharmacologic therapies in pain management 3. Explain the role of opioid antagonist in the diagnosis and treatment of acute opioid toxicity 4. Describe the nurse s role in the pharmacologic management of patients receiving analgesics and antimigraine drugs 5. Review prototype drugs including actions and uses, administration Morphine (Astramorph PF, Duramorph), Nalaxone (Narcan), Aspirin (Acetylsalicylic Acid, ASA), Sumatriptan (Imitrex) Coagulation Disorders (Chapter 30) 1. Illustrate the major steps of hemostasis 2. Describe thromboembolic disorders that are indicators for coagulation modifiers

10 Week 7 03/27/ Explain how laboratory testing of coagulation parameters is used to monitor anticoagulant pharmacotherapy 4. Describe the nurse s role utilizing the nursing process in the pharmacologic management of coagulation disorders 5. Review prototype drugs including actions and uses, administration Heparin, Warfarin (Coumadin), Clopidogrel (Plavix), Alteplase (Activase) Hematopoietic Disorders (Chapter 31) 1. Describe the process of hematopoiesis 2. Describe Vitamin 12 deficiency (pernicious or megaloblastic anemia) and Iron deficiency anemia 3. Describe the nurse s role utilizing the nursing process in the pharmacologic management of hematopoietic disorders 4. Review prototype drugs including actions and uses, administration Epoetin Alfa (Epogen, Procrit), Filgrastim (Neupogen), Cyanocobalamin (Vitamin B 12 ), Ferrous Sulfate (Feosol) Hypertension (Chapter 25) 1. Explain hypertension (HTN) classification 2. Summarize long-term consequences of untreated hypertension 3. Explain the effects of cardiac output, peripheral resistance, and blood volume on blood pressure 4. Describe the nurse s role utilizing the nursing process in the pharmacologic management of patients receiving drugs for hypertension 5. Review prototype drugs including actions and uses, administration Spironolactone (Aldacton), Enalapril (Vasotec), Nifedipine (Procardia XL) Hydralazine (Apresoline) Heart Failure (Chapter 26) 1. Define Heart Failure (HF) 2. Review the blood circulation 3. Relate how the symptoms associated with heart failure may be caused by weakened heart muscle and diminsihed cardiac output 4. Explain how preload and afterload affect cardiac function 5. Describe the nurse s role utilizing the nursing process in the pharmacologic management of heart failure 6. Review prototype drugs including actions and uses, administration Lisinopril (Prinivil, Zestril), Furosemide (Lasix), Digoxin (Lanoxin), Metoprolol (Lopressor, Toprol XL) Angina Pectoris and Myocardial Infarction (Chapter 27) 1. Explain the pathophysiology of myocardial infarction 2. Describe factors that affect myocardial oxygen supply and demand 3. Describe the nurse s role utilizing the nursing process in the 4. pharmacologic management of patients with myocardial infarction

11 Week 8 04/03/2014 Week 9 04/10/2014 Review prototype drugs including actions and uses, administration Nitroglycerin (Nitrostat, Nitro-Bid, Nitro-Dur), Atenolol (Tenormin), Dilitiazem (Cardizem), Retaplase (Retavase) Asthma and Other Pulmonary Disorders (Chapter 39) 1. Identify major functions of the lower respiratory tract 2. Compare the advantages and disadvantages of using the inhalation route of the drug administration for pulmonary drugs 3. Describe the nurse s role utilizing the nursing process in the pharmacologic treatment of lower respiratory tract disorders Review prototype drugs including actions and uses, administration Albuterol (Proventil), Ipratropium (Atrovent), Beclomethasone (Qvar) Bacterial Infections (Chapter 34) 1. Explain how bacteria are described and classified 2. Explain how resistance can develop to an anti-infective drug 3. Explain the importance of culture and sensitivity 4. Describe the nurse s role utilizing the nursing process in the pharmacologic management of bacterial infections 5. Review prototype drugs including actions and uses, administration Penicillin G, Gentamycin (Garamycin), Ciprofloxacin (Cipro), Trimethoprim-sulfamethoxazole (Bactrim, Septra) Viral Infections (Chapter 36) 1. Identify viral infections that benefit from pharmacotherapy 2. Explain the purpose and expected outcomes of HIV pharmacotherapy 3. Explain the advantage of HAART in the pharmacotherapy of HIV infection 4. Describe the nurse s role utilizing the nursing process in the pharmacologic management of patients receiving antiretroviral and antiviral drugs 5. Review prototype drugs including actions and uses, administration Zidovudine (Retrovir, AZT), Acyclovir (Zoviraz) Neuromuscular Disorders (Chapter 21) 1. Discuss nonpharmacologic therapies used to treat muscle spasms and spasticity 2. Explain the goals of pharmacotherapy with skeletal muscle relaxants 3. Describe the nurse s role in the pharmacologic management of muscle spasms 4. Review prototype drugs including actions and uses, administration Cyclobenzaprine (Flexeril), Dantrolene Sodium (Dantrium)

12 Bone and Joint Disorders (Chapter 47) 1. Describe the role of calcium in the body in maintaining homeostasis in the nervous, muscular, and nervous systems 2. Explain the pharmacotherapy of hypocalcemia, osteomalacia, osteoporosis, rickets, osteoarthritis, rheumatoid arthritis, and gout 3. Describe the nurse s role in the pharmacologic management of disorders related to bones and joints Review prototype drugs including actions and uses, administration Calcium Salts, Calcitrol (Calcijex, Rocaltrol), Alendronate (Fosamax), Raloxifene (Evista), Hydroxycholorquine (Plaquenil), Allopurinol (Lopurin) Week 10 04/17/2014 Week 11 04/24/2014 Week 12 05/01/2014 SPRING BREAK Degenerative Diseases of the Nervous System (Chapter 20) 1. Describe symptoms of Parkinson s disease and Alzheimer s disease 2. Explain the goals of pharmacotherapy for Alzheimer s disease and the efficacy of existing medications 3. Describe the nurse s role utilizing the nursing process in the pharmacologic management of Parkinson s disease and Alzheimer s disease Review prototype drugs including actions and uses, administration Levodopa, Carbidopa, Benztropine (Cogentin), Donepezil (Aricept) Diabetes Mellitus (Chapter 44) 1. Describe the endocrine and exocrine functions of the pancreas 2. Compare and contrast type 1 and type 2 diabetes mellitus 3. Compare and contrast types of insulin 4. Describe the signs and symptoms of insulin overdose and underdose 5. Describe the nurse s role in the pharmacologic management of diabetes mellitus Review prototype drugs including actions and uses, administration Human Regular Insulin (Humulin R, Novolin R), Metformin (Fortamet, Glucophage, Glumetza) Diuretic Therapy and Drugs for Renal Failures (Chapter 23) 1. Explain the role of the kidneys in maintaining fluid, electrolyte, and acid base balance 2. Describe the adjustments in pharmacotherapy that must be considered n patients with renal failure 3. Identify indications for diuretics 4. Describe the general adverse effects of diuretic pharmacotherapy

13 Week 13 05/08/2014 Week 14 05/15/ Compare and contrast the loop, thiazide, and postassium-sparing diuretics 6. Describe the nurse s role in the pharmacologic management of renal failure, and in diuretic therapy 7. Review prototype drugs including actions and uses, administration Hydrochlorothiazide (Microzide) Fluid Balance, Electrolytes, and Acid-Base Disorders (Chapter 24) 1. Describe conditions for which IV fluid therapy may be indicated 2. Explain the pharmacotherapy of sodium and potassium imbalances 3. Discuss common causes of alkalosis and acidosis and the medications used to treat these disorders 4. Describe nurse s role utilizing the nursing process in the pharmacological management of fluid balance, electrolyte, and acid-base disorders Review prototype drugs including actions and uses, administration Dextran 40, Sodium Chloride (NaCl), Potassium Chloride (KCl) Peptic Ulcers Disease (Chapter 40) 1. Describe major anatomical structures of upper GI tract 2. Identify common causes, signs, and symptoms of peptic ulcer disease Describe nurse s role utilizing the nursing process in the pharmacological management of patients with peptic ulcer disease 3. Review prototype drugs including actions and uses, administration Ranitidine (Zantac), Omeprazole (Prilosec), Aluminum Hydroxide Bowel Disorders and Other Gastrointestinal Conditions (Ch. 41) 1. Identify major anatomic structures of lower GI tract 2. Explain the pathogenesis of constipation and diarrhea 3. Discuss conditions in which the pharmacotherapy of bowel disorders is indicated 4. Explain conditions in which pharmacotherapy of nausea/vomiting (N/V) is indicated 5. Describe nurse s role utilizing the nursing process in the pharmacological management of bowel disorders, N/V, and other GI conditions 6. Review prototype drugs including actions and uses, administration Psyllium mucilloid (Metamucil), Diphenoxylate with Atropine (Lomotil), Metoclopramide (Reglan), Ondansetron (Zofran) Disorders and Conditions of the Female Reproductive System (Chapter 45) 1. Describe the role of the hypothalamus, pituitary, and ovaries in maintaining female reproductive function 2. Explain the mechanisms by which estrogens and progestins

14 prevent conception 3. Explain how drugs may be used to provide emergency contraception and to terminate early pregnancy 4. Describe the role of drug therapy in the treatment of menopausal and postmenopausal symptoms 5. Discuss the use of progestins in the therapy of dysfunctional uterine bleeding 6. Compare and contrast the use of uterine stimulants and relaxants in the treatment of antepartum and postpartum patients 7. Explain how drug therapy may be used to treat female infertility. 8. Describe the nurse s role in the pharmacologic management of disorders and conditions of the female reproductive system 9. Review prototype drugs including actions and uses, administration Estradiol and Norethindrone (Ortho-Novum), Conjugated Estrogens (Cenestin, Enjuvia, Premarin), Medroxyprogesterone (Depo- Provera), Ocytocin (Pitocin) Week 15 05/22/2014 Disorders and Conditions of the Male Reproductive System (Chapter 46) 1. Describe the role of the hypothalamus, pituitary, and testes in regulating male reproductive system 2. Describe the misuse and dangers associated with the use of anabolic steroids to enhance athletic performance 3. Explain the role of medications in the treatment of male infertility 4. Describe the etiology, pathogenesis, and pharmacotherapy of erectile dysfunction 5. Describe the pathogenesis of benign prostatic hyperplasia 6. Describe the nurse s role in the pharmacologic management of disorders and conditions of the male reproductive system 7. Review prototype drugs including actions and uses, administration Testosterone, Sildenafil (Viagra), Finasteride (Proscar) Autonomic Nervous System (Chapter 13) 1. Identify the basic functions of the nervous system: central nervous system and peripheral nervous system 2. Compare and contrast the actions of the sympathetic and parasympathetic divisions of the autonomic nervous system 3. Describe the nurse s role utilizing the nursing process in the pharmacologic management of patients receiving drugs affecting the autonomic nervous system 4. Review prototype drugs including actions and uses, administration Phenylephrine (Neo-Synephrine), Atropine (Atro-Pen) Dysrhythmias (Chapter 29) 1. Explain how rhythm abnormalities can affect cardiac function

15 Week 16 05/29/ Illustrate flow of electrical impulses through normal heart 3. Classify dysrhythmias based on their location and type of rhythm abnormality 4. Describe nurse s role in the pharmacological management of patient with dysrhythmias 5. Review prototype drugs including actions and uses, administration Amiodarone (Cordarone) Shock (Chapter 28) 1. Compare and contrast different types of shock 2. Relate general symptoms of shock to their physiologic causes 3. Explain initial treatment priorities for a patient who is in shock 4. List drugs used in the pharmacotherapy of anaphylaxis 5. Review prototype drugs including actions and uses, administration Normal Normal Serum Albumin (Albuminar, Plasbumin), Norepinephrine (Levophed), Dopamine (Dopastat, Intropin), Epinephrine (Adrenalin) Comprehensive Final

16 Appendix A Drug Presentation The purpose of this assignment is to provide students with an opportunity to actively participate in their learning, teach others what they have learned, and practice the art of public speaking in a safe and supportive environment. Objectives: To familiarize students with common prototype drugs related to each body system as specified by instructor To gain an understanding of drug classification, pharmacodynamics, chemical interactions, and toxicology in medication administration Assignment: Students will be divided into groups of 4 or 5 students each. Each group will be provided with a prototype drug to research and present the following key elements: Trade name/genetic name Classification of Medication Indications Actions Pharmacokinetics Contraindications/Precautions Common Adverse Reactions/Side Effects Dosages and Calculations Patient and Family Teaching Students will select the following choices to present the assigned drug: Powerpoint Presentation, Teaching Brochure, Game, Website, Situational Role Play, and Educational Workshop. Students may utilize any source of instructional media as needed to convey required information to class. Examples may include, but is not limited to internet media, books, lap tops, handouts, props, etc.

17 *Groups are set and final. It is possible that students may withdraw from the course. Therefore, the remaining members of the group will still be responsible for all required elements of the assignment. *See Appendix C and Appendix D.

18 Appendix B Medication Dosage and Calculation I. Systems of Medication Measurements A. Metric System The metric system is the commonly used system of measurement for prescribing and administering medications. The metric system is a decimal system based on multiples of ten. Numbers to the left of the decimal are whole numbers and numbers to the right of the decimal are fractions of whole numbers. Each number has a place value. The value of each place is ten times the value of the place immediately to its right. The first number after the decimal point is the tenth place. 0.1 is read as one tenth (1/10). The second number after the decimal point is the hundredth place is read as one hundredth (1/100). The third number after the decimal point is the thousandth place is read as one thousandth (1/1000). Because each place is a multiple of ten, moving a decimal point one place produces a 10-fold change in the number. A medication error involving a misplaced decimal point can result in serious under or overdosages of a medication. For example, if a nurse gives 12ml of a medication instead of 1.2ml, the patient will receive 10 times the dose! The metric system has three basic units of measure: meter (length), liter (volume), and gram (weight). Metric units important in dosage calculations are liter (L) and gram (gm). Common prefixes are used to indicate the value of each unit of length, volume, or weight. The following indicate smaller parts than the basic unit of measure: Prefix Value Decimal Equivalent Relationship to Basic Unit (meter, liter, gram) deci = one tenth = 0.1 = 10 times smaller centi = one hundredth = 0.01 = 100 times smaller milli = one thousandth = = 1,000 times smaller micro = one millionth = = 1,000,000 times smaller One prefix indicates a larger unit than the basic unit of measure:

19 Kilo = one thousand = = 1000 times greater It is helpful to memorize some of the common metric unit abbreviations and their equivalents used in clinical dosage calculations (Table 1). Table 1. Metric Equivalents WEIGHT 1 kilogram (kg) = 1000 grams (g) 1 gram (g) = 1000 milligrams (mg) 1 milligram (mg) = 1000 micrograms (mcg) (cc) VOLUME 1 liter (L) = 1000 milliliters (ml) or 1000 cubic centimeters 1 milliliter (ml) = 1 cubic centimeter (cc) *The cubic centimeter (cc) is the amount of space the 1mL occupies. The two measures are interchangeable. As shown above, each of the common units of measure used in dosage calculations differs from the next by Since each place is a multiple of ten and each zero represents one place value, to convert between these units of measure the decimal point is moved three places. The direction the decimal point is moved is dependent on whether the value is moving down to a smaller unit of measure or moving up to a larger unit of measure. If moving down in value, the quantity becomes larger so the decimal point is mover three places to the right (Table 2). If moving up in value, quantities become smaller and the decimal point is moved three places to the left (Table 3). Being able to convert these common units is important when calculating dosages. Table 2. Moving down in value. Example: 0.5 gm is equivalent to how many milligrams? 0.5gm = 500mg We converted down the scale. Milligrams are a smaller unit of measure than grams. To convert grams to milligrams, move the decimal point three places to the right and change the units of measurement to milligrams. In order to do this, two zeros must be added.

20 Another method to convert grams (large) to milligrams (small) is to multiple by gm x 1000 = 500mg Table 3. Moving up in value. Example: 2500mL is equivalent to how many liters? 2500mL = 2.5L We converted up the scale. A liter is a larger unit of measure than a milliliter. To convert ml to L, move the decimal point three places to the left and change the units to L. Once done, it is possible to drop two zeros as retaining them does not change the value. Another method to convert milliliters (small) to liters (large) is to divide by mL 1000 = 2.5L Errors in metric system dosage calculations occur more frequently when the dosage contains a decimal. Whenever possible, perform the conversions to eliminate the decimal point. It is also important to always place a zero in front of decimal fractions (Table 4). Table 4. Proper Notation..3 mg is an improper notation 0.3mg is the correct notation B. Other systems of medication measurement. Unit Medications are sometimes measured in units. A unit measures a medication in terms of its action rather than its weight. There are three major medications measured in units: Heparin, Penicillin, and Insulin.

21 Milliequivalents Milliequivalents (meq) are the number of grams of a medication contained in a ml of solution. Milliequivalents are used to designate measurement in a variety of solutions, especially electrolytes. Percentage Percentages (%) are parts per hundred. Specifically, percentages represent the number of grams of medication per 100mL of solution. Please note, the higher the percentage strength, the stronger the mixture. Percentages, as a unit of measure, are used in solutions, topical ointments and other medications. The following illustrates the concentration of medications expressed as percentages: Lidocaine 2% = 2gm of medication per 100mL of solution D10W = 10gm of dextrose per 100mL of water Notice that the denominator is always 100, and the numerator shows how many parts out of 100 (Table 5). Table 5. Changing percent (%) to fraction. 1. Drop the % sign 2. Write the number as the numerator 3. Write 100 as the denominator 4. Reduce to lowest terms Example: Dextrose 5% = 5gm = 1gm mL II. Dosage Calculations Tablets and capsules each contain a specific amount of medication (Table 6). Most tablets and capsules come in multiples of the ordered dosage. When necessary, scored tablets may be divided. Most orders requiring giving ½ to 3 tablets. If a nurse s calculation results in an unusual number, this could be a warning that a calculation mistake has been made. Liquid medication preparations contain a specific amount of medication in a certain volume of solution. Table 6. Medication Preparations. Example:

22 One medication may come in a tablet and liquid preparation. Tablet = 250mg tablet Liquid = 250mg/5mL When the dosage ordered is different from what is available, dosage calculations are necessary. There are several different ways to calculate medication dosages. The following section will present two common methods of dosage calculations for preparing oral and parenteral medications, dimensional analysis and ratio and proportion (Table 7). Practice the medication calculations using each method presented. Then select one method and work the study questions. A. Medication calculation using dimensional analysis Dimensional analysis is a method to calculate medication doses using fractions. With dimensional analysis, the problem is set up according to the following: D H x Q D represents the desired dosage or what the physician has ordered H represents the dosage on hand or the strength available Q represents the quantity that contains the available dose X represents the volume desired and is the unknown value Table 7. Steps to calculate medication dosages using dimensional analysis 1. Ensure all units are in the same size. Convert if necessary in a manner that will eliminate the decimal point. When converting be sure to convert to units of the available medication 2. Estimate what would be a reasonable amount to administer 3. Place all the information into the correct position in the formula 4. Calculate the answer Examples: #1 Order: 600 mg PO Available: 300 mg tablets

23 necessary Step 1: Units are already in the same size (mg), no conversion in Step 2: A reasonable estimate is that more than 1 tablet will be given because the dosage ordered is larger than the dosage on hand Step 3: (D)600 mg x (Q)1 tablet = X (H)300 mg Step 4: 600 mg x 1tab = 2 tablets 300 mg #2 Order: mg PO Available: 50 mcg scored tablets Step 1: Convert to like units. Convert mg to mcg, to eliminate the decimal point. To do this, multiple by 1000 or move the decimal point 3 places to the right and change units to mcg: mg = 25 mcg Step 2: A reasonable estimate is that less than 1 tablet will be given because the dosage ordered is less than the dosage on hand Step 3: (D) 25 mcg x (Q)1 tablet = X (H) 50 mcg Step 4: 25 mcg = ½ tab 50 mcg #3 Order: 50 meq PO Available: 20 meq/15ml Step 1: Units are already in the same size, no conversion is necessary Step2: A reasonable estimate is that more than 15mL will be given because the dosage ordered is more than the dosage on hand Step 3: (D) 50 meq x (Q) 15 ml = X (H) 20 meq Step 4: 50 meq x 15 ml = 75 = 37.5 ml 20 meq 2 B. Medication calculations using ratio and proportion method A ratio is a comparison of two numbers which are somehow related to each other. A medication dosage ratio can be used to show the amount of medication contained in one tablet. A dosage ration can also be used to show the amount of medication in a given volume of solution. These relationships (ratios) are expressed by either placing a colon between the numbers or writing the numbers in fraction form (Table 8). Table 8. Expression of a ratio.

24 A medication is available in a dose of 250mg per 5 ml. The ration is expressed as: 5mL: 250mg or 250mg 5ml A proportion is used to prove that two ratios are equal (Table 9 and 10). A proportion me be separated by an equal sign (=) or double colon (::). Table 9. Expression of a proportion written as a fraction 250 = Read as 250 is to 1 as 500 is to 2 Table 10. Expression of a proportion written as a ratio 250 : 1 : 500 : 2 Read as 250 is to 1 as 500 is to 2 Means 250 : 1 :: 500 : 2 Extremes Proof of the ratios in a proportion being equal is demonstrated by cross multiplication. When expressed as a fraction, the numerator (top number) of each ratio is multiplied by its opposite denominator (bottom number). When expressed as a ratio, the inside numbers are multiplied, then the outside numbers are multiplied. The products in a true proportion are equal. In the above example in Table 9, the product (answer) of the numerator in the ratio on the left 250 multiplied by the denominator in the ratio on the right 2 is 500. The product of the numerator in the ratio on the right 500 multiplied by the denominator in the ratio on the left 1 is 500. Thus, these ratios are equal. In Table 10, proof of the ratios being equal is evident by multiplying the means (1 x 500 = 500) and multiplying the extremes (250 x 2 = 500). Ratio and proportion can be used to calculate dosages when only one complete ratio is known and the second is incomplete. If three numbers of the ratio are known, the fourth can be determined. In the ratio and proportion method of dosage calculation, the unknown number is represented by X. When setting up a proportion, remember the following key points: Ratio for known equivalent = ration for unknown equivalent. Keep the known information on the left.

25 X Set up the equation according to the following: If using fractions, set up like this: dosage on hand = dosage desired amount on hand amount desired (X) If using ratio, set up like this: Dosage on hand : amount on hand : dosage desired : amount desired (X) X Label the units and sure the units in the numerators match and the units in the denominators match Example (fraction): Example (ratio): Order: 150 mg Order: 150 mg Available: 100mg/2 ml Available: 100 mg/ 2 ml Units on left of the ratio are the same Numerators are the same 100 mg = 150 mg 2mL x ml Denominators are the same same 100 mg : 2 ml : 150 mg : x ml Units on right of the ratio are the Table 11. Steps to calculate medication dosages using ratio and proportion method 1. Ensure all units are in the same size, converting if necessary. When converting be sure to convert to the units of the available medication 2. Estimate what would be a reasonable amount to administer 3. Set up the problem as a proportion 4. Calculate the answer by multiplying and solving for X Example: #1 Order: 600mg PO Available: 300 mg tablets Step 1: No conversion necessary

26 Step 2: A reasonable estimate is that more than one tablet will be given because the dosage ordered is more than the dosage on hand Step 3: 300 mg = 600 mg 1 tablet X tablet Step 4: Cross multiply, keeping X on the left side of the equation 300 mg = 600mg 1 tablet X tablet 300X = 600 Solve for X by dividing the number on the right side of the equation by the number in front of X. 300X = X = 2 tablets #2 same problem, but in this example, the equation is set up using ratios Step 1: No conversion necessary Step 2: A reasonable estimate is more than 1 tablet will be given because the dosage ordered is more than the dosage on hand Step 3: 300 : 1 :: 600 : X Step 4: Multiply means and extremes multiply 300X = : 1: : 600: X multiply Solve for X by dividing the number equation by the number in front of X 300X = X = 2 tablets 3# Order: mg Po Available: 50 mcg scored tablets Step 1: Convert to like units. To convert mg to mcg, move the decimal point 3 places to the right and change the units to mcg: mg = 25 mcg Step 2: A reasonable estimate is that less than 1 tablet will be given because the dosage ordered is less than the dosage on hand Step 3: 50 mcg = 25 mcg 1 tab X tablet

27 Step 4: Cross multiply and solve for X 50 mcg = 25 mcg 1 tablet X tablet 50X = 25 50X = X = 0.5 or ½ tablet #4 Order: 50mEq PO Available: 20 meq/ 15 ml Step 1: Units are already in the same size, no conversion is necessary Step 2: A reasonable estimate is that more than 15 ml will be given because the dosage ordered is more than the dosage on hand Step 3: 20 meq = 50mEq 145 ml X ml Step 4: Cross multiply and solve for X 20mEq = 50mEq 15mL X ml 20X = X = X = 37.5 ml

28 Appendix C Grading Rubric for Drug Card Presentation Content / Development 20 Points All key elements of the assignment are covered in a substantive way: Provided generic (or official name) and common trade name(s) (as applicable) Provided accurate classification of medication Demonstrated knowledge of different drug indications for use Described adequately actions and therapeutic effects selected drug Defined the key components of pharmacokinetics including absorption, distribution, metabolism/excretion, and half-life Explained sufficiently drug contraindications and precautions Listed 3-5 adverse reactions and side effects Provided accurate and common adult dosages and calculations Points Earned XX/20 Additional Comments: Mechanics 5 Point Followed rules of grammar, usage, and punctuation No spelling noted Sentences were complete, clear, Points Earned XX/5 Additional Comments:

29 and concise Overall Presentation/Peer Review 5 Points Points Earned XX/5 Total Presentation was given in minutes Group was well prepared and organized for presentation Group was communicated thoroughly and accurately about selected drug Additional Comments: Points Earned 30 Points XX/30 Overall Comments:

30 Appendix D Study Group Peer Evaluation Name & Drug: Date: Objectively evaluate the team s performance on the following questions. Students attempt to rate without regard to positive or negative feelings that you may have for individual members. Must submit on scheduled presentation day to receive credit. Using the scale below, individually rate each member of your group, including yourself. 1= No Participation 2= Slight Participation 3= Moderate participation 4= Significant Participation 5= Outstanding Participation Study Group Member Preparedness (Research, reading, and assignment complete) Attendance (On-time and stayed for duration) Participation (Contributed best academic ability) Communication between meetings (Initiates and responds appropriately) Overall Contribution

31