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Pharmacology for Nursing - KUHS BSc Nursing Syllabus
This covers all major topics in the KUHS BSc Nursing Pharmacology curriculum (Pharmacology I - Semester III, Pharmacology II - Semester IV), taught in the context of what a nurse needs to know to administer drugs safely and effectively.
UNIT 1: General Pharmacology (Principles of Therapeutics)
1.1 Introduction
Pharmacology is the science that studies the origin, nature, chemistry, effects, and uses of drugs. For nurses, the focus is on safe drug administration and patient outcomes.
Key definitions:
- Drug: Any chemical substance that alters the biological function of an organism
- Pharmacology: Study of drugs and their interactions with living systems
- Therapeutics: The use of drugs to treat, prevent, or diagnose disease
- Pharmacognosy: Study of natural sources of drugs (plants, animals, minerals)
1.2 Pharmacokinetics (What the Body Does to the Drug)
Pharmacokinetics describes ADME: Absorption, Distribution, Metabolism, Excretion. These processes collectively determine the drug concentration delivered to target tissues.
"The processes of absorption, distribution, metabolism, and excretion - collectively termed drug disposition - determine the concentration of drug delivered to target effector molecules."
- Harrison's Principles of Internal Medicine, 22nd Ed.
A - Absorption
The movement of a drug from the site of administration into the bloodstream.
| Route | Absorption | Onset | Nursing Note |
|---|---|---|---|
| IV (intravenous) | 100% (directly into blood) | Immediate | Most rapid; irreversible |
| IM (intramuscular) | Good | 10-30 min | Monitor injection site |
| SC (subcutaneous) | Moderate | 15-30 min | Slower than IM |
| Oral (PO) | Variable | 30-60 min | Most common; first-pass effect |
| Sublingual | Good | 2-5 min | Bypasses first-pass |
| Rectal | Erratic | Variable | Used when oral route unavailable |
| Topical/Transdermal | Slow, sustained | Hours | Steady drug levels |
| Inhalation | Rapid | Minutes | Good for respiratory drugs |
First-Pass Effect: When a drug is taken orally, it passes through the intestinal epithelium -> portal vein -> liver, where it may be significantly metabolised before reaching systemic circulation. This reduces bioavailability.
Bioavailability: The fraction of administered drug that reaches systemic circulation unchanged.
D - Distribution
After absorption, drugs distribute to tissues via the bloodstream. Factors affecting distribution:
- Blood-Brain Barrier (BBB): Only lipid-soluble, uncharged drugs cross easily
- Plasma protein binding: Drugs bound to albumin are pharmacologically inactive; only free drug acts
- Volume of distribution (Vd): Apparent volume in which drug distributes; large Vd = drug goes into tissues
- Lipid solubility: Lipophilic drugs penetrate tissues more
M - Metabolism (Biotransformation)
Primarily in the liver (also kidneys, lungs, GI tract). Converts drugs to metabolites (usually inactive, more water-soluble) for excretion.
- Phase I reactions: Oxidation, reduction, hydrolysis (cytochrome P450 enzymes)
- Phase II reactions: Conjugation (glucuronidation, sulfation) - makes drug more water-soluble
- Enzyme induction (e.g., rifampicin): Increases metabolism, reduces drug effect
- Enzyme inhibition (e.g., ketoconazole): Decreases metabolism, increases drug effect/toxicity
E - Excretion
Primary route: kidneys (urine). Other routes: bile/faeces, lungs, sweat, breast milk.
- Half-life (t½): Time for plasma drug concentration to fall by 50%. Determines dosing interval.
- Steady state: Reached after ~4-5 half-lives of regular dosing
- Renal impairment reduces drug excretion - nurse must monitor for toxicity and expect dose adjustments
1.3 Pharmacodynamics (What the Drug Does to the Body)
Drug-Receptor Theory
Most drugs work by binding to specific receptors (proteins on cell surfaces or inside cells).
| Concept | Definition |
|---|---|
| Agonist | Drug that binds receptor AND activates it (mimics natural ligand) |
| Antagonist | Drug that binds receptor but does NOT activate it (blocks agonist) |
| Partial agonist | Binds and partially activates receptor |
| Affinity | How strongly a drug binds to its receptor |
| Efficacy | Maximum effect a drug can produce |
| Potency | Amount of drug needed to produce a given effect |
Dose-Response Relationship
- Therapeutic dose: Dose that produces desired effect
- Toxic dose: Dose that produces harmful effects
- Lethal dose (LD50): Dose lethal to 50% of a test population
- Effective dose (ED50): Dose effective in 50% of the population
- Therapeutic Index (TI) = LD50 / ED50 - Wider TI = safer drug
- Narrow TI drugs require careful monitoring: digoxin, warfarin, lithium, phenytoin, aminoglycosides
1.4 Routes of Drug Administration
Enteral (through GI tract): Oral, sublingual, buccal, rectal
Parenteral (bypassing GI tract):
- IV - fastest onset, used in emergencies
- IM - deep muscles (deltoid, gluteus, vastus lateralis)
- SC - fatty tissue under skin
- Intradermal (ID) - skin testing (e.g., Mantoux test)
- Intrathecal, epidural, intraosseous (specialised)
Other routes: Topical, transdermal, inhalation, nasal, ophthalmic, otic
1.5 Drug Nomenclature and Classification
Every drug has three names:
- Chemical name: Exact molecular structure (e.g., N-acetyl-p-aminophenol)
- Generic/nonproprietary name: Approved common name (e.g., paracetamol/acetaminophen)
- Brand/proprietary name: Manufacturer's trademarked name (e.g., Crocin, Dolo)
Classification of drugs:
- By pharmacological action (e.g., analgesics, antihypertensives)
- By therapeutic use (e.g., antibiotics, antiemetics)
- By chemical structure (e.g., penicillins, benzodiazepines)
- By mechanism (e.g., ACE inhibitors, beta-blockers)
1.6 Factors Affecting Drug Action
| Factor | Effect |
|---|---|
| Age | Neonates/elderly have altered metabolism; reduced renal/hepatic function |
| Body weight | Affects dosing (mg/kg dosing in children) |
| Sex | Hormonal differences; pregnancy alters pharmacokinetics |
| Genetics | Pharmacogenomics - rapid vs. slow metabolisers |
| Disease states | Liver disease (metabolism), renal disease (excretion) |
| Drug interactions | Synergism, antagonism, additive effects |
| Tolerance | Decreased response after repeated doses |
| Psychological factors | Placebo effect |
| Time of administration | Chronopharmacology |
1.7 Adverse Drug Reactions (ADRs)
| Type | Description | Example |
|---|---|---|
| Side effect | Predictable, unavoidable effect at therapeutic dose | Dry mouth with antihistamines |
| Toxic effect | Due to overdose | Paracetamol hepatotoxicity |
| Allergic reaction | Immune-mediated | Penicillin anaphylaxis |
| Idiosyncratic | Unpredictable, genetically determined | Primaquine causing haemolysis in G6PD deficiency |
| Teratogenic | Harm to fetus | Thalidomide |
| Drug dependence | Physical/psychological addiction | Opioids, benzodiazepines |
| Tolerance | Need for increasing dose | Morphine |
Nurse's responsibility: Document and report ADRs; educate patients; monitor vitals.
1.8 Drug Interactions
- Pharmacokinetic interactions: One drug alters the ADME of another (e.g., rifampicin increases metabolism of oral contraceptives)
- Pharmacodynamic interactions:
- Synergism: Combined effect greater than individual (e.g., alcohol + sedatives)
- Antagonism: One drug reduces effect of another (e.g., naloxone reverses opioids)
- Additive: Combined effect equals sum of individual effects
1.9 Indian Pharmacopoeia and Drug Laws
- Indian Pharmacopoeia (IP): Official compendium of drug standards in India
- Drugs and Cosmetics Act, 1940: Regulates import, manufacture, distribution, and sale of drugs
- Schedule H drugs: Prescription-only (e.g., antibiotics, psychotropics) - cannot be sold without a doctor's prescription
- Schedule X drugs: Habit-forming drugs requiring special prescription
- Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985: Controls narcotics and psychotropics
Nurse's Legal Responsibility:
- Administer only prescribed drugs
- Verify drug name, dose, route, time, patient identity (5 Rights: right drug, right dose, right route, right time, right patient - extended to 9 rights in modern practice)
- Keep controlled substances locked; maintain records
UNIT 2: Antiseptics and Disinfectants
| Agent | Use | Mechanism |
|---|---|---|
| Alcohol (70% ethanol/isopropanol) | Hand rub, skin disinfection | Protein denaturation |
| Povidone-iodine (Betadine) | Wound care, surgical scrub | Releases free iodine, oxidises proteins |
| Chlorhexidine | Skin antisepsis, oral rinse | Membrane disruption |
| Hydrogen peroxide (3%) | Wound cleaning | Releases oxygen, mechanical debridement |
| Phenol (carbolic acid) | Disinfection of surfaces | Protein coagulation |
| Savlon (chlorhexidine + cetrimide) | Wound cleaning | Antiseptic + detergent |
| Spirit of chloroform | Surface disinfection | Protein denaturation |
Antiseptic = used on living tissue. Disinfectant = used on inanimate objects.
Nurse's role: Maintain asepsis, select appropriate agent, observe for skin reactions, prevent infection.
UNIT 3: Drugs Acting on the GI System
| Drug Group | Examples | Use | Nurse's Note |
|---|---|---|---|
| Antacids | Aluminium hydroxide, Magnesium hydroxide (Digene), Sodium bicarbonate | Peptic ulcer, GERD, hyperacidity | Monitor for constipation (Al) or diarrhoea (Mg); give 1 hr after meals |
| H2 blockers | Ranitidine, Famotidine | Peptic ulcer | Monitor for headache, dizziness |
| Proton Pump Inhibitors (PPIs) | Omeprazole, Pantoprazole | Peptic ulcer, GERD | Give 30 min before meals; long-term use depletes Mg, B12 |
| Antiulcer | Sucralfate, Misoprostol | Mucosal protection | Sucralfate: give on empty stomach |
| Emetics | Ipecac syrup, Apomorphine | Induce vomiting in poisoning | KUHS: Now rarely used; contraindicated in corrosive poisoning |
| Antiemetics | Metoclopramide, Ondansetron, Domperidone, Promethazine | Nausea, vomiting, chemotherapy | Ondansetron: most commonly used; monitor for QT prolongation |
| Laxatives | Bisacodyl, Lactulose, Ispaghula, Magnesium sulfate | Constipation, bowel prep | Prevent fluid/electrolyte imbalance; avoid prolonged use |
| Antidiarrhoeals | Loperamide, ORS, Zinc | Diarrhoea | ORS is first-line; loperamide contraindicated in children with bloody diarrhoea |
UNIT 4: Analgesics and Anti-inflammatory Drugs
Non-opioid Analgesics (NSAIDs)
| Drug | Use | ADR | Nurse's Note |
|---|---|---|---|
| Paracetamol (Acetaminophen) | Mild-moderate pain, fever | Hepatotoxicity in overdose | Safest analgesic; max 4g/day in adults |
| Aspirin | Pain, fever, anti-inflammatory, antiplatelet | GI ulceration, Reye's syndrome | Avoid in children <12 yrs; used in MI/stroke prevention |
| Ibuprofen | Pain, inflammation, dysmenorrhoea | GI upset, renal impairment | Give with food |
| Diclofenac | Musculoskeletal pain, arthritis | GI, cardiovascular risk | Monitor BP in long-term use |
| Indomethacin | Gout, ankylosing spondylitis | GI most prominent | Used to close patent ductus arteriosus in neonates |
Opioid Analgesics (Narcotic)
| Drug | Use | ADR | Nurse's Note |
|---|---|---|---|
| Morphine | Severe pain, pulmonary oedema | Respiratory depression, constipation, nausea, dependence | Keep naloxone (antidote) available; monitor respiration |
| Codeine | Mild-moderate pain, cough | Constipation, nausea | Prodrug converted to morphine in liver |
| Pethidine (Meperidine) | Obstetric pain, acute pain | Respiratory depression, seizures (norpethidine metabolite) | Caution in renal impairment |
| Tramadol | Moderate-severe pain | Seizure risk, serotonin syndrome | Lower dependence risk than morphine |
| Fentanyl | Severe pain, anaesthesia | Respiratory depression | Transdermal patch available |
| Naloxone | Opioid antidote | Withdrawal symptoms | IV/IM; short-acting, may need re-dosing |
UNIT 5: Antimicrobials
Antibiotics
| Class | Examples | Used For | Nurse's Note |
|---|---|---|---|
| Penicillins | Amoxicillin, Ampicillin, Benzylpenicillin | Gram +ve infections, syphilis | Ask about penicillin allergy before administering |
| Cephalosporins | Cefalexin (1st gen), Cefuroxime (2nd), Ceftriaxone (3rd) | Broad spectrum; surgical prophylaxis | Cross-sensitivity with penicillin ~1-2% |
| Aminoglycosides | Gentamicin, Amikacin, Streptomycin | Serious gram -ve infections, TB | Ototoxic and nephrotoxic - monitor renal function and hearing |
| Macrolides | Erythromycin, Azithromycin, Clarithromycin | Atypical pneumonia, Helicobacter pylori | Alternative for penicillin allergy |
| Tetracyclines | Doxycycline | Malaria prophylaxis, acne, atypical infections | Avoid in pregnancy, children <8 yrs (stains teeth); take with water, avoid dairy |
| Fluoroquinolones | Ciprofloxacin, Levofloxacin | UTI, respiratory, GI infections | Avoid in children; can cause tendon rupture |
| Sulfonamides | Cotrimoxazole (Trimethoprim + Sulfamethoxazole) | UTI, PCP prophylaxis | Adequate fluid intake needed; can cause Stevens-Johnson syndrome |
Antitubercular Drugs (ATDs)
First-line DOTS regimen:
- RIPE = Rifampicin + Isoniazid + Pyrazinamide + Ethambutol
- Rifampicin: turns urine/body fluids orange-red (warn patient); enzyme inducer
- Isoniazid: peripheral neuropathy - give pyridoxine (Vit B6) to prevent
- Pyrazinamide: hepatotoxicity, hyperuricaemia
- Ethambutol: optic neuritis - monitor visual acuity
Antimalarials
| Drug | Use | Note |
|---|---|---|
| Chloroquine | P. vivax, P. malariae | Retinal toxicity with long-term use |
| Artemisinin combinations (ACT) | P. falciparum | First-line for falciparum malaria |
| Primaquine | Radical cure of P. vivax; gametocidal | Causes haemolysis in G6PD deficiency - screen before use |
| Doxycycline/Mefloquine | Prophylaxis |
Antiviral Drugs
| Drug | Use |
|---|---|
| Acyclovir | Herpes simplex, Varicella-Zoster |
| Oseltamivir (Tamiflu) | Influenza |
| Antiretroviral drugs (ARVs) | HIV - NRTIs, NNRTIs, PIs, Integrase inhibitors |
| Remdesivir | COVID-19 (antiviral, select cases) |
Antifungal Agents
| Drug | Use | Nurse's Note |
|---|---|---|
| Fluconazole | Candidiasis, Cryptococcal meningitis | Hepatotoxic; monitor LFTs |
| Amphotericin B | Severe systemic fungal infections | Nephrotoxic; monitor renal function; give IV slowly |
| Clotrimazole/Miconazole | Topical fungal infections |
Anthelmintics
| Drug | Use |
|---|---|
| Albendazole | Roundworm, hookworm, tapeworm |
| Mebendazole | Pinworm, roundworm, hookworm |
| Praziquantel | Schistosomiasis, tapeworm |
| Ivermectin | Strongyloides, scabies, onchocerciasis |
UNIT 6: Drugs Acting on the Cardiovascular System
| Drug Class | Examples | Use | Nurse's Note |
|---|---|---|---|
| Cardiac glycosides | Digoxin | Heart failure, atrial fibrillation | Narrow TI - monitor pulse (hold if <60); check potassium (hypokalaemia increases toxicity) |
| Antihypertensives | |||
| - ACE inhibitors | Enalapril, Ramipril | Hypertension, heart failure, diabetic nephropathy | Dry cough (common ADR); monitor potassium; avoid in pregnancy |
| - ARBs | Losartan, Valsartan | Same as ACE inhibitors (for those who can't tolerate) | Less cough than ACEi |
| - Beta blockers | Atenolol, Metoprolol | Hypertension, angina, arrhythmia, heart failure | Monitor pulse and BP; do not stop abruptly |
| - Calcium channel blockers | Amlodipine, Nifedipine, Diltiazem | Hypertension, angina | Monitor BP; ankle oedema (amlodipine) |
| - Diuretics | Furosemide (loop), Hydrochlorothiazide (thiazide), Spironolactone (K-sparing) | Hypertension, heart failure, oedema | Monitor electrolytes (K+), urine output, weight |
| Antianginals | Nitrates (GTN, Isosorbide), Beta-blockers, CCBs | Angina pectoris | GTN: sublingual; can cause headache, hypotension |
| Antiarrhythmics | Lidocaine, Amiodarone, Adenosine | Arrhythmias | Monitor ECG, BP, HR |
| Anticoagulants | Heparin (IV/SC), Warfarin (oral) | DVT, PE, AF, prosthetic valves | Heparin antidote: Protamine sulfate; Warfarin antidote: Vitamin K; monitor PT/INR |
| Antiplatelet | Aspirin, Clopidogrel | MI prevention, stroke prevention, PCI | Watch for bleeding; do not stop without physician advice |
| Thrombolytics | Streptokinase, tPA (Alteplase) | Acute MI, massive PE, acute ischaemic stroke | Monitor for bleeding; narrow time window |
| Antihyperlipidaemics | Atorvastatin, Rosuvastatin | High cholesterol | Monitor LFTs, muscle pain (myopathy); avoid in pregnancy |
UNIT 7: Drugs Acting on the Respiratory System
| Drug | Class | Use | Nurse's Note |
|---|---|---|---|
| Salbutamol (Albuterol) | Short-acting beta-2 agonist (SABA) | Acute asthma relief | Shake inhaler; teach correct technique; can cause tremor, tachycardia |
| Salmeterol/Formoterol | Long-acting beta-2 agonist (LABA) | Asthma/COPD maintenance | Not for acute attacks |
| Ipratropium | Anticholinergic bronchodilator | COPD, acute severe asthma | Dry mouth, urinary retention in BPH |
| Theophylline | Xanthine derivative | COPD, asthma | Narrow TI; monitor blood levels; causes nausea, arrhythmia |
| Beclomethasone/Budesonide | Inhaled corticosteroid (ICS) | Asthma prevention | Rinse mouth after use to prevent oral candidiasis |
| Prednisolone/Dexamethasone | Systemic corticosteroid | Severe asthma, COPD exacerbation | Short-term use; long-term causes osteoporosis, hyperglycaemia, immunosuppression |
| Codeine/Dextromethorphan | Cough suppressant (antitussive) | Dry cough | Codeine has addiction potential |
| Bromhexine/Ambroxol | Mucolytic/expectorant | Productive cough | Encourage adequate fluid intake |
| Antihistamines (1st gen) | Chlorphenamine, Promethazine | Allergic rhinitis, urticaria | Sedating; useful as antiemetic, anti-motion sickness |
| Cetirizine/Loratadine | 2nd generation antihistamines | Allergic conditions | Non-sedating |
UNIT 8: Drugs Acting on the Nervous System
CNS Depressants
| Drug Class | Examples | Use | Nurse's Note |
|---|---|---|---|
| Benzodiazepines | Diazepam, Lorazepam, Midazolam, Clonazepam | Anxiety, insomnia, seizures, alcohol withdrawal | Dependence risk; antidote: Flumazenil; avoid in elderly (fall risk) |
| Barbiturates | Phenobarbitone | Epilepsy (older use), anaesthesia induction | Respiratory depression; strong enzyme inducer |
| General Anaesthetics | Thiopentone (IV), Halothane, Isoflurane (inhalational), Ketamine | Surgical anaesthesia | Nurse: airway management, monitoring under anaesthesia |
| Opioids | (see Unit 4) |
Antiepileptic Drugs (AEDs)
| Drug | Type of Epilepsy | ADR |
|---|---|---|
| Phenytoin | Tonic-clonic, partial | Gingival hyperplasia, teratogenic, enzyme inducer |
| Sodium valproate | Broad spectrum | Hepatotoxic, teratogenic, weight gain |
| Carbamazepine | Tonic-clonic, partial, trigeminal neuralgia | Aplastic anaemia, Stevens-Johnson syndrome |
| Levetiracetam | Broad spectrum | Behavioural changes, well-tolerated |
| Phenobarbitone | Tonic-clonic (esp. in children) | Sedation, enzyme induction |
| Ethosuximide | Absence seizures | GI disturbance |
Nurse's role: Ensure regular dosing; educate about not stopping suddenly; monitor drug levels for narrow TI drugs.
Antipsychotics (Neuroleptics)
| Drug | Class | Use |
|---|---|---|
| Chlorpromazine | Typical (1st gen) | Schizophrenia, psychosis |
| Haloperidol | Typical (1st gen) | Schizophrenia, acute agitation |
| Risperidone, Olanzapine, Clozapine | Atypical (2nd gen) | Schizophrenia, bipolar disorder |
ADRs: Extrapyramidal symptoms (EPS) - Parkinsonism, tardive dyskinesia, akathisia, acute dystonia. Clozapine: agranulocytosis - monitor CBC weekly.
Antidepressants
| Class | Examples | Use |
|---|---|---|
| SSRIs | Fluoxetine, Sertraline, Escitalopram | Depression, OCD, panic disorder |
| Tricyclics (TCAs) | Amitriptyline, Imipramine | Depression, neuropathic pain, enuresis |
| MAOIs | Phenelzine | Atypical depression (rarely used) |
| SNRIs | Venlafaxine, Duloxetine | Depression, anxiety, neuropathic pain |
Important: Serotonin syndrome risk with multiple serotonergic drugs. All antidepressants increase suicide risk in <25 years initially.
UNIT 9: Drugs Acting on the Endocrine System
Insulin and Oral Hypoglycaemics
| Drug | Type | Duration | Nurse's Note |
|---|---|---|---|
| Regular (Soluble) Insulin | Short-acting | 6-8 hrs | Give 30 min before meal |
| Lispro/Aspart | Rapid-acting | 3-5 hrs | Give immediately before meal |
| NPH Insulin | Intermediate | 12-18 hrs | Cloudy; rotate injection sites |
| Glargine/Detemir | Long-acting (basal) | 24 hrs | Clear; do not mix |
| Metformin | Biguanide | Oral | First-line in type 2 DM; hold before contrast imaging; risk of lactic acidosis |
| Sulfonylureas | Glibenclamide, Glipizide | Oral | Hypoglycaemia risk; watch for low blood sugar |
| SGLT2 inhibitors | Empagliflozin, Dapagliflozin | Oral | Urinary/genital infections; DKA risk |
| DPP-4 inhibitors | Sitagliptin | Oral | Generally well-tolerated |
Hypoglycaemia (blood sugar <70 mg/dL): Give glucose/dextrose immediately; serious complication of insulin or sulfonylureas.
Thyroid Drugs
| Drug | Use | Nurse's Note |
|---|---|---|
| Levothyroxine (T4) | Hypothyroidism | Take on empty stomach; start low, go slow in elderly/cardiac |
| Carbimazole/Propylthiouracil (PTU) | Hyperthyroidism | Monitor for agranulocytosis; sore throat is warning sign |
| Radioactive iodine (I-131) | Hyperthyroidism, thyroid cancer | Radiation precautions |
Corticosteroids
Examples: Prednisolone, Dexamethasone, Hydrocortisone
Uses: Inflammation, asthma, autoimmune diseases, adrenal insufficiency, chemotherapy anti-emesis
Long-term ADRs (Cushingoid effects): Hyperglycaemia, hypertension, osteoporosis, peptic ulcer, immunosuppression, adrenal suppression, moon face, buffalo hump, striae
Nurse: Never stop abruptly (adrenal crisis risk); give with food to protect GI tract.
UNIT 10: Drugs Acting on the Reproductive System
| Drug | Use | Nurse's Note |
|---|---|---|
| Oxytocin | Induction/augmentation of labour, PPH prevention | IV infusion only; monitor contractions, fetal heart |
| Ergometrine | PPH treatment | IV or IM; causes powerful uterine contraction |
| Progesterone | Threatened abortion, luteal phase support, contraception | |
| Combined oral contraceptive pill (COCP) | Contraception, dysmenorrhoea, PCOS | VTE risk; drug interactions with rifampicin, anticonvulsants |
| Emergency contraception | Levonorgestrel | Within 72 hours of unprotected sex |
| Misoprostol | Induction, PPH | Cause uterine contraction |
| Tocolytics | Nifedipine, Salbutamol, Ritodrine | Premature labour |
UNIT 11: Rational Use of Drugs and Nurse's Role
The 9 Rights of Drug Administration:
- Right drug
- Right dose
- Right route
- Right time
- Right patient
- Right documentation
- Right reason
- Right response
- Right to refuse
Nurse's Responsibilities:
- Know the drug before giving it (action, dose, side effects)
- Verify prescription clearly; clarify doubts before administration
- Never administer an unlabelled drug
- Monitor therapeutic effects and ADRs after administration
- Educate patients about their medications
- Maintain medication records accurately
- Report medication errors immediately
- Handle controlled drugs per hospital and legal protocols
- Store drugs correctly (e.g., insulin refrigerated, light-sensitive drugs in dark containers)
UNIT 12: Key Drug Antidotes (Important for Examinations)
| Poisoning / Overdose | Antidote |
|---|---|
| Opioid overdose | Naloxone |
| Benzodiazepine overdose | Flumazenil |
| Paracetamol overdose | N-Acetylcysteine (NAC) |
| Heparin overdose | Protamine sulfate |
| Warfarin overdose | Vitamin K (or FFP for urgent reversal) |
| Organophosphate poisoning | Atropine + Pralidoxime |
| Digoxin toxicity | Digoxin-specific antibody fragments (Digibind) |
| Iron poisoning | Desferrioxamine |
| Heavy metal poisoning | Chelating agents (EDTA, BAL, Penicillamine) |
| Cyanide poisoning | Sodium nitrite + Sodium thiosulfate (or Hydroxocobalamin) |
Quick Revision: High-Yield Points for KUHS Exams
- Narrow Therapeutic Index drugs (require monitoring): Digoxin, Warfarin, Phenytoin, Lithium, Theophylline, Aminoglycosides
- Nephrotoxic antibiotics: Aminoglycosides (gentamicin), Vancomycin, Amphotericin B
- Ototoxic drugs: Aminoglycosides, Furosemide, Aspirin (high dose)
- Teratogenic drugs (Class X/D): Thalidomide, Warfarin, Phenytoin, Valproate, ACEi, Methotrexate, Tetracyclines
- Enzyme inducers: Rifampicin, Phenytoin, Carbamazepine, Phenobarbitone, Alcohol (chronic)
- Enzyme inhibitors: Ketoconazole, Erythromycin, Ciprofloxacin, Cimetidine
- Drugs requiring empty stomach: Levothyroxine, Proton pump inhibitors, Sucralfate
- Drug-induced colour change in urine: Rifampicin (orange-red), Iron supplements (black stools), Nitrofurantoin (yellow-brown)
- Antidotes (see Unit 12 above) - commonly asked in exams
- Five Rights should be recited as 9 Rights in clinical context
Sources: Katzung's Basic and Clinical Pharmacology 16th Ed.; Harrison's Principles of Internal Medicine 22nd Ed.; Lippincott Illustrated Reviews Pharmacology; Goodman & Gilman's The Pharmacological Basis of Therapeutics; KUHS BSc Nursing Syllabus 2021 (Semesters III-IV)
This covers the complete KUHS BSc Nursing Pharmacology syllabus from Pharmacology I (Semester III) through Pharmacology II (Semester IV), including the mandatory Fundamentals of Prescribing module. Would you like me to go deeper into any specific unit or create practice questions for exam preparation?
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