Using the Pharm Phorm

In every classification, certain drugs are picked as prototypes or representative drugs that you will see over and over in your practice. To facilitate your understanding of significant drugs, the Pharm Phorm highlights clinical indications, adverse reactions, and nursing implications. For each prototype drug, you should fill out a Pharm Phorm and use them as study guides, quick clinical reference material and analytical tools. Some students choose to maintain a notebook of 81/2 x 11 sheets while others use the “recipe box” size. In any case, file the phorms by drug class.

Note: All ASN courses that incorporate drugs into the content will use the Pharm Phorm as a basic learning tool. Each subsequent course identifies drugs associated with certain disease entities and asks you to fill out the pharm phorm. Resist the temptation to use commercial, pre-prepared drug cards, as a significant amount of learning occurs by organizing and writing out the drug data.

The master Pharm Phorm is presented on the next page. It is probably best to print copies of the form and then use drug references and the textbook to find the relevant information. The drugs are clearly identified in this course material under the heading PROTOTYPE –followed by drug class as in PROTOTOYPE OPIOIDS. The first Pharm Phorm has been completed for you as an example. Every phorm will request the same type of information. You will need to use both the textbook and your drug reference to complete the pharm phorms.

Read through the completed sample Pharm Phorm again. What did you just learn about morphine? You will see the dose start to take effect quickly. What side effect will you check within 15 minutes after dose? Respiratory rate. Is morphine potentially addictive? Yes. Is it good for pregnant women? No.

Congratulate yourself if you comprehended most of what was written on the sample phorm –you’ve come a long way! Working back and forth between the textbook and drug handbook, complete a phorm for the prototype opioid analgesic meperidine (Demerol).

Pharm Phorm

Prototype drug: morphine sulfate (MS Contin, Duramorph)

Class: Opioid Analgesic

Clinical Indications: (top three)

1. Severe pain

2. Pulmonary edema

3. Heart attack pain

Mechanism of Action: binds to opiate receptors in CNS, alters perception of pain

General CNS depression

Side/Adverse Effects: (adverse in bold)

· Respiratory depression — hold if respirations less than 10

· Confusion and sedation

· Low blood pressure (hypotension)

· Constipation

· Shock, cardiac arrest, thrombocytopenia

Route and Dosage: Adults only

· PO, Rectal 30 mg q 3-4 hr

· IM, IV, SC 4-8 mg q 3-4hr

· Continuous infusion 0.8-10 mg/hr

Nursing Implications: (top 3)

1. Monitor level of consciousness, BR, HR and R routinely.

2. Assess bowels q 4 hrs, give laxatives if required.

3. Assess pain level before and after dosing to check effectiveness.

Patient Teaching

· No alcohol or other CNs depressants

· May open sustained release caps but do not chew or crush pellets

· Change position slowly to avoid orthostatic hypotension

· Long term use may result in phsyical dependency

Other Considerations: (controlled substance; narrow therapeutic window; short half-life; peak and trough; antidote,etc.)

· Schedule II

· Rapid onset

· Antidote to overdose – naloxone (Narcan) IV, O2, IV fluid

References

Vallerand, A. H., Sanoski, C. A., Deglin, J. H. (2015). Davis’s drug guide for nurses

(14th ed.). Philadelphia, PA: F.A. Davis.