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Parenteral Dosage of Drugs Chapter 11 MAT 119 Parenteral Routes • Route of administration other than gastrointestinal – Intramuscular (IM) – Subcutaneous (subcut) – Intradermal (ID) – Intravenous (IV) 2 3 Z-Track Injection Z-Track 4 Parenteral Routes Used to describe drugs given by any route other than oral, sublingual, topical, or rectal • Generally associated with drugs administered by a needle • The term “parenteral” means by injection. 5 Parenteral Routes • Benefits: Good for drugs that are poorly absorbed, rapid response, patient is uncooperative, unconscious, etc. • Disadvantage: Expensive, require skilled personnel, is an invasive technique 6 Parenteral Routes All routes have limitations: • Limited to solutions, suspensions, and emulsions • Must be sterile (bacteria-free) • pH must be maintained • May require buffers • Volume limited (IM, ID, Subcut) 7 Parenteral Medications • Most parenteral medications are prepared in liquid form and packaged in single, or multi-dose vials – Ampules or prefilled syringes 8 Parenteral dosages Round amount to be administered to tenths if the amount is greater than 1 mL and measure it in a 3 mL syringe Order: Administer 1.33 mL = 1.3 mL 9 Parenteral dosages • Measure amounts less than 1 mL rounded to hundredths and all amounts less than 0.5 mL in a 1 mL syringe. • Order: Administer 0.65 mL 10 Parenteral dosages • Amounts of 0.5 mL to 1 mL calculated in tenths can be accurately measured in either a 1 mL or a 3 mL syringe (usually use 3 mL for IM > 0.5 mL) • Order: Administer 0.6 mL 11 Calculation of Drug Dosage: Parenteral Order: Cleocin 150 mg IM q 12h Available: Cleocin (clindamycin phosphate) 300 mg per 2 mL 12 Three Steps • Step 1: Convert – All units of measurement must be in same system and all units must be in same size • Step 2: Think – Estimate logical amount • Step 3: Calculate Dosage on hand = Dosage desired Amount on hand X amount desired D desired Q (quanity) X H (have) 13 Cleocin 150 mg IM q.12h Available: Cleocin (clindamycin phosphate) 300 mg per 2 mL • Step 1: Convert – No conversion is necessary • Step 2: Think – You want to give less than 2 mL – Actually, you want to give 150 mg, which is 1/2 of 300 mg and 1/2 of 2 mL, or 1 mL – Calculate to double-check your estimate 14 Cleocin 150 mg IM q.12h Available: Cleocin (clindamycin phosphate) 300 mg per 2 mL • Step 3: Calculate 150 mg D Q 2 mL H 300 mg 1mL 300 mg = 150 mg 2 mL X Give 1 mL Cleocin IM every 12 hours 15 Calculation of Drug Dosage: Parenteral • Order: Robinul 100 mcg IM stat • Supply: Robinul 0.2 mg per mL Convert: Equivalent: 1 mg = 1,000 mcg 0.2 mg = 0.200 = 200 mcg Think: Give less than 1 mL about 1/2 Don’t be fooled into thinking 0.2 mg is less than 100 mcg 0.2 mg is more than 100 mcg 0.2 mg = 200 mcg 16 continued • Order: Robinul 100 mcg IM stat • Supply: Robinul 0.2 mg per mL Step 3: Calculate: D 100 mcg Q 1 mL H 200 mcg 1 mL 0.5 mL 2 200mcg 100mcg X 0.5mL 1mL X 17 continued • Give IM • Select a 1 mL syringe • Measure 0.5 mL Robinul 0.2 mg per mL • You have to change needles, as this is an IM injection. • Change to 1-1 1/2” needle 18 Insulin Label Find: Supply dosage/concentration Total volume Brand name Type Manufacturer Label alerts Generic Name Species 19 Insulin • Supply dosage of insulin is 100 units per mL • Abbreviated on label as U-100 • Syringe must also be U-100 • Accuracy is critical • Nurses must understand and correctly interpret insulin order and label • The correct syringe must be selected 20 Insulin Syringes Standard U-100 50 Lo-Dose U-100 30 Lo-Dose U-100 21 Interpreting the Insulin Order • Brand name, including the species and action time. – Rapid-acting (Regular) – Intermediate-acting (NPH) – Long-acting (Lantus) • Supply dosage (concentration and number of units to be given) • Route of administration and time or frequency – Regular insulin only type to be given IV 22 Examples • Humulin R Regular U-100 insulin 14 units subcut stat • Novolin N NPH U-100 insulin 24 units subcut 1/2 hour ā breakfast 23 Types of Insulin 24 Other Delivery Systems Insulin Pump 25 Inhaled Insulin 26 Insulin Sliding Scale Insulin Dose Glucose Reading* No coverage 2 units Glucose less than 160 160–220 4 units 6 units 8 units 221–280 281–340 341–400 *Glucose greater than 400: Hold insulin, call MD stat Order: Humulin R Regular U-100 insulin subcut a.c. based on sliding scale p. 229 #26-30 27 Insulin: Avoiding Errors • Check dosage with two nurses • When combination dosages are prepared, two nurses must verify each step of the process. 28 29