1. PHARMACOLOGY FOR NURSES B y : M s. H a d r a t u l A s l i y a h, S. F a r m., A p t

2. What’s in YOUR scope ? DOCTOR DOCTOR NURSE PHARMACIST Diseases diagnosis Care plan Drug therapy

3. GOAL ?

4. HOW TO GET (Y)OUR COMPETENCY : -Diseases & its cause -Drug & its therapy -Patient & the treatment Your focus is here !!! But u can’t left the 2 other ya ^^

5. NICE QUOTE : “Terapi Pengobatan yang efektif dan aman hanya dapat dicapai bila pasien mengetahui seluk beluk pengobatan dan kegunaannya“ This is our JOB !!!

6. DRUG DRUG MECHANISM DRUG INTERACTION DOSE & CALCULATION DOSE & CALCULATION HOW TO ADMINISTER DRUG TYPE / CLASS OF DRUGS

7. Drugs Calculation Reference : Tambayong, Jan,dr., 2001, Farmakologi untuk Keperawatan, Widya Medika, Jakarta. Wallace, Laurence B ; Guide for Calculating Medication. www.jsu.edu/nursing/linkdocs/DrugCalc/NU325.pdf Starkings, Susan ; Drug Calculation and The Mathematics Required for Nursing. www.health.heacademy.ac.uk/rp/resources/articles/sst arkings

8. Household System VS Metric System VS Apothecaries System Household : lbs, c, inch, tea spoon, glass, etc Metric : ml, g, gr, kilo, centi, dexa, etc Apothecaries : fl oz, cc, etc Grain  gr 1 = 60 mg Fluid ounces  1 fl oz (US) = 29.57353 ml *check USP, FI 1 kg = 2.2 lbs

11. ACCURATE ? VS

12. CONVERSION EXAMPLE : RATIO  PERCENT 1 : 5 = …. % 1 : 2000 = …. % PERCENT  RATIO 0,02 % = … : … 1,5 % = … : … 2 ------ 100 1 ------ 100 X= 2 ----------- 10.000 1 ----------- 5.000

13. What is that mean? Is it Solid or Liquid ? -If it’s SOLID = gram -If it’s LIQUID = mililiter 5 g --------- 100 g 1 X= 5 % = 0,05 g/g = 50 mg/g

14. HOW TO CALCULATE ? Simple Three-Step Approach to Dosage Calculations: Step 1: Convert : Ensure all measurements are in the same system of measurement and the same size unit of measurement. If not, convert. Step 2: Think WHAT’S AVAILABLE : Estimate what is a reasonable amount of the drug to be administered. Step 3: Calculate : Apply the formula: I x Jt T = X * I = dosis yg diminta, Jt = Jumlah tersedia, T = dosis yg tersedia, X = hasil

15. Oral Dosage How many Digoxin tablets that you need to get 0,125 mg ? *each tablet contain 62,5 mcg Digoxin 0,125 mg = (0,125 x 1000) mcg = 125 mcg I x Jt T = X 125 mcg / X tab 125 mcg x 1 tab ------------------------ = ------------------------- = 2 tab 62,5 mcg / 1 tab 62,5 mcg

16. Injection Dosage The physician ordered Phenobarbital 30 mg. you have on hand an ampule of Phenobarbital containing 60 mg per 5 ml. how many ml of medication will you give? I x Jt T = X 30 mg / X ml 30 mg x 5 ml ------------------ = --------------------- = 2,5 ml 60 mg / 5 ml 60 mg

17. Injection Dosage The physician ordered Morphine 4 mg IM. You have Morphine containing 10 mg in 2 ml. How many ml should you give? Chose the correct syringe and shade in the appropriate amount of medication. I x Jt T = X 4 mg / X ml 4 mg x 2 ml ------------------ = -------------------- = 0,8 ml 10 mg / 2 ml 10 mg

19. Intravena Dose (infusion rate) Formula for Calculating Intravenous Fluids total ml fluid to be given total ml fluid to be given 1. ml/hr  -------------------------------- = desired ml/hr hours to be infused hours to be infused desired volume x drop factor desired volume x drop factor 2. drops/min  ------------------------------------- = desired gtts/minutes total number of minutes total number of minutes Jumlah tetesan / ml larutan

20. Infusion Dosage Physician orders 2000 ml of fluids to infuse in 16 hours. You have available the Baxter administration set with drop factor of 10. how many cc/hour should fluids infuse? And how many drops/minutes? Desired volume : 2000 ml Drop factor : 10 Total number of minutes = 16 hour = 16 x 60 minutes = 960 minutes

21. ml/hr total ml fluid to be given total ml fluid to be given ml/hr  -------------------------------- = desired ml/hr ml/hr  -------------------------------- = desired ml/hr hours to be infused hours to be infused 2000 ml 2000 ml -------------- = 125 ml/hr = 125 cc/hr -------------- = 125 ml/hr = 125 cc/hr 16 hr 16 hr * 1 cc = 1 ml Hour = jam

22. drops/minutes desired volume x drop factor desired volume x drop factor drops/min  ------------------------------------- = desired gtts/minutes total number of minutes total number of minutes 2000 x 10 2000 x 10 --------------- = 28,3 gtts/minutes --------------- = 28,3 gtts/minutes 960 960

23. Pediatric dosages RULE : to verify safe pediatric dosing 1.convert the child’s weight (if it’s different) 2.calculate the safe dosage in mg/kg or mcg/kg as recommended 3.Compare the ordered dose to the recommended dose and decide if the dosage is safe

24. How to convert Adult Dose to Child Dose (pediatric) ? RUMUS MENGHITUNG DOSIS: CLARK : w/70 x DM Dewasa YOUNG : w/(n+20) X DM Dewasa DM DILLING : n/20 X DM Dewasa COWLING : (n+1)/24 X DM Dewasa FRIED : m/150 X DM Dewasa  dosis Bayi Keterangan : W = Berat Badan ( Kg ) n = Umur ( tahun ) m = Umur ( bulan)

25. DOSIS OBAT Dosis suatu obat : adalah dosis pemakaian sekali untuk peroral atau injeksi,Dalam pemberian terapi obat yg rasional DOSIS TERAPI (DT) Dosis individual yg tertulis di resep dg tujuan pengobatan DOSIS LAZIM (DL) Dosis yang tercantum di literatur yg lazimnya dapat menyembuhkan, dosis tersebut sebagai acuan dalam menetapkan dosis terapi per individual Contoh : Erithromicin Sekali minum : 250 mg – 500 mg Seharinya : 1000 mg – 2000 mg DOSIS MAKSIMUM (DM) Dosis terbesar yg dpt memberikan efek terapi tanpa menimbulkan bahaya Contoh : Erithromicin Sekali minum : 500 mg Seharinya : 4000 mg

26. How to convert Adult Dose to Child Dose (pediatric) ? Berdasarkan Luas Permukaan Tubuh (BSA) LUAS PERMUKAAN TUBUH (m 2 ) LUAS PERMUKAAN TUBUH (m 2 ) DOSIS PEDIATRI = ------------------------------------------------- x Dosis Dewasa 1,73 1,73 See : Pediatric Dose Chart : Pediatric Dose Chart: Pediatric Dose Chart

27. Example : The physician orders morphine sulfate 1.8 mg IM stat. The child weighs 79 lb. Is this dosage safe? Step 1: Convert lbs. to kilograms (2.2 lb. = 1 kg) 79 / 2.2 = 35.91 or 35.9 kg. 79 / 2.2 = 35.91 or 35.9 kg. Step 2: Calculate mg/kg as recommended by a reputable drug resource. (A reputable drug resource indicates that the usual IM/SC dosage may be initiated at 0.05 mg/kg/dose.) Per dose= 35.9 kg x 0.05 mg = 1.79 mg = 1.8 mg/dose Step 3: Decide if the dosage is safe by comparing ordered and recommended dosages. For this child’s weight, 1.8 mg is the recommended dosage and 1.8 mg is the ordered dosage. Yes, the order is safe.

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

29. Answer : The PDR gives the dosage range as 50-80 mg. per kg. per day to be given in divided doses of q 8 hours. The child weighs 32 pounds. 32 lbs = …. Kg  32 / 2.2 = 14.5 kg recommended dose = 50-80 mg/kg/day  50 mg/kg/day x 14.5 kg = 725 mg/day 80 mg/kg/day x 14.5 kg = 1160 mg/day

30. Cont… The physician’s order reads “Keflin” 1000 mg. IV q6hrs recommended dose = 725 mg/day – 1160 mg/day it means that the dosage is NOT in the safe range. How many mg should be given per dose? if 1000 mg / day = …… mg/ 6 hours 1000 mg / 24 hours 1000 mg x 6 hours ---------------------------- = ----------------------------- = 250 mg q6hrs X mg / 6 hours 24 hours

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32. TRY TO ANSWER THIS : A 50-pound child is to receive 0.2 mg/kg. How many mg. of a medication is the correct dose for this child? Albuterol 1.2 mg po t.i.d. for an 18 kg child with severe asthma. Recommended dosage from the manufacturer: 0.2mg/kg/day orally in three equally divided doses. Is the order safe? Ordered: Dilantin 30 mg T.I.D. PO for a 2 year old child weighing 39.6 pounds. Safe dose for this age group is 5mg/kg/day. On hand is Dilantin Pediatric Suspension 125mg/5ml. How many ml. would you give per dose?

33. ALHAMDU….. LILLAH…