Pharmacology exam

There were originally “five rights” applied to medication administration (Bullock & Manias, 2022). The first five rights remain unchanged and are outlined below (Johnson et al., 2022). However, many international midwifery and nursing professional organisations (e.g., in Ireland, New Zealand, the UK, and USA) as well as many Australian maternity services are calling for an additional three to five rights to be added to the original five rights of medication administration. All ten rights are included below as they apply to the midwifery practice of medication administration in Australia:

 1.Right medicine [medication]:

• Right medicine (matches the order and the woman’s / infant’s condition).

• Generic names should always be used by the prescriber, plus approved abbreviations and clear, printed handwriting.

• It is not the right medication if the woman / infant has an allergy.

 2.Right dose:

• The dose matches the order and is safe for the woman / infant.

• The correct dose must be given, and attention paid to decimal points to avoid large errors.

 3.Right route:

• The route matches the order and is appropriate for the woman / infant.

• Medications must be administered by the route prescribed.

• This has become more challenging as complexity increases and more options become available.

• Medications must be labelled correctly.

 4.Right time:

• The time matches the order, the administration frequency and times.

• Medications must be administered at the correct time to ensure appropriate therapeutic serum levels (usually within 30 minutes of the prescribed time is acceptable).

• Medications must also be prepared at the right time (not hours ahead) and,

• given over the correct time as medications given too rapidly can be dangerous.

 5.Right person:

• The right woman / infant is confirmed using three identifiers if possible:

• Identification number

• Name

• Date of birth on wristband and medication chart.

• The medication must be administered to the woman / infant for whom it was prescribed.

• The woman is asked to state her (or her infant’s) name and date of birth.

(Bullock & Manias, 2022; Johnson et al., 2022).

6.Right sharing of information with the woman:

• Does the woman understand what the medication is for?

• Are they aware of potential side effects / reactions and which health care professional they should contact if they experience any adverse reactions.

• Has the information shared been non-biased and evidence-based?

7.Right documentation:

• Prior to the medication being administered, it must have been prescribed correctly with a start and end date if appropriate.

• After the medication has been administered, it must be signed for.

• Document and report any medication errors / adverse effects immediately.

8.Right to accept / decline / refuse medication:

• Providing the woman has the capacity to do so, she has the right to accept or decline medication on behalf or herself or her infant.

• Information shared to ensure the woman’s informed choice to accept or decline the medication must be done in a way that is uncoerced, unbiased and based on best available evidence.

(see sub-topic 1.2 below).

9.Right assessment:

• Check that the woman / infant actually needs the medication.

• Check for contraindications.

• Attend baseline observations if required.

10.Right evaluation:

• Ensure the medication is working in the way it should.

• Ensure medications have been regularly reviewed.

• Attend ongoing observations as required.

• (Bodell, 2022; New Zealand Nurses Organisation, 2018; Vera 2020)

Module 1

The sixth and eighth rights of medication administration relate to women’s right to make informed choices about the medication(s) they (or their infant) are taking and to have those choices respected. Midwives have the responsibility to share information to ensure women are enabled to make a fully informed choice (or decline) and to always have their decision respected.

Epomedicine (2020) has published a mnemonic that would assist midwives in supporting women to make informed choices about their medications. The mnemonic is BRAIN, and its components relate to:

Benefits: what are the benefits of taking this medication for the woman / her infant?

Risks: what are the potential risks / side effects / adverse effects of this medication for the woman or her infant?

Alternatives: Are there any alternatives available? If so, what are they (this mnemonic would also apply to alternatives)?

Indications: Why is this medication being prescribed / administered?

Nothing: What are the likely outcomes if the woman chooses to do nothing (doesn’t take the medication)? What are the likely outcomes if she chooses to accept the medication, compared with if she declines the medication.

All information shared with the woman must be accurate, non-biased, based on best available evidence and in a way that is never coercive. All women, with the capacity to make informed choices must have their choice respected.

Module 1

The following content notes and answers to frequently asked questions are informed by the Australian Government, Department of Health and Aged Care (2025). 

When was the Australian categorisation system for prescribing medicine in pregnancy last updated?

2025

What does the Australian categorisation system consider?

It is acknowledged that most medications cross the placenta. The categorisation system considers the harmful effects of medications on fetal development and their potential to cause:

• Birth defects

• Unwanted pharmacological effects around the time of birth, which may or may not be reversible.

• Problems across the lifespan.

Why do some medications have more than one pregnancy category?

Some medications are definitely teratogenic and carry a category X, for most medications the risk of developing birth defects also depends on:

• Systemic exposure of the mother

• Exposure of the fetus, which may be affected by:

• Dose

• Route of administration

• Dosing regimen.

Is the system hierarchical?

No! Unlike the USA system.

It is important to note that:

• Human data are lacking or inadequate for medications in the B1, B2 and B3 categories.

• Subcategorisation of the B category is based on animal data.

• The allocation of a B category does not imply greater safety than a C category.

• Medications in category D are not absolutely contraindicated during pregnancy (e.g. anticonvulsants).

• If there are two or more active ingredients in a medication, the combinations is based on the active ingredient with the most restrictive pregnancy categorisation.

What are the definitions of the Australian categories for prescribing medicines in pregnancy?

Category A

Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.

Category B1

Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed.

Studies in animals have not shown evidence of an increased occurrence of fetal damage.

Category B2

Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed.

Studies in animals are inadequate or may be lacking, but available data show no evidence of an increased occurrence of fetal damage.

Category B3

Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed.

Studies in animals have shown evidence of an increased occurrence of fetal damage, the significance of which is considered uncertain in humans.

Category C

Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible. Accompanying texts should be consulted for further details.

Category D

Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.

Category X

Drugs which have such a high risk of causing permanent damage to the fetus that they should not be used in pregnancy or when there is a possibility of pregnancy.

The first topic explored legal, ethical and professional frameworks governing medication administration; including:

• The “rights” of medicationadministration

• Informed choice and medications

• Review of medication calculations

The second topic will address the principles of pharmacokinetics.

Module 1

Any medication that is administered should reach the circulatory system or bloodstream for it to reach the target tissue (the body part that the medication exerts its action). Pharmacokinetics in simplest terms is the way the body handles a medication (Broyles et al., 2019). The body views medication as a foreign body and will try to eliminate the medication. So, pharmacokinetics is what the body does from the time the medication enters the body (administered) to the time it leaves the body (eliminated). Pharmacokinetics is a process, which involves:

• Absorption

• Distribution

• Metabolism

• Excretion

• Bioavailability

• Plasma concentration

• Therapeutic range

• Half-life

• Steady-state concentration

All of which will be defined in the sub-topics below. Understanding this information is very important in ensuring proper monitoring of the therapeutic effect of each medication you will administer including the importance of ensuring that you administer medications at correct frequencies and duration.

module 1