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Week 2Medication Orders and Measurement Systems Jack Lazarre, Pharm.D. 1 Medication Order Issues Are you expected to know everything? – No healthcare professional is Tip Obtain a good, current reference When in doubt ask – No silly questions related to patient safety 2 JCAHO (Joint Commission on Accreditation of Healthcare Organizations) Created an Official “Do Not Use” List – Why? easily misinterpreted abbreviations increased risk of errors compromised patient safety Remember “The Five Rights” 3 “Do Not Use” List Examples DON’T DO 1. “u” or “IU” for units 1. Spell out the word “units” 2. “q.d." "qd" "Q.D." "QD“ 2. Spell out the word “daily” 3. “Q.O.D.” 3. Spell out “every other day” The Joint Commission on Accreditation of Healthcare Organizations. The Official “Do 4 Not Use List”.Retrieved September 29, 2007, http://www.jointcommission.org “Do Not Use” List Examples DON’T DO 1. Trailing zero – “5.0 mg” 1. Avoid the use of a zero after a decimal point – “5” 1. Decimal point without a leading zero – “.5” can be mistaken for “5” 2. Use a leading zero before a decimal – “0.5” The Joint Commission on Accreditation of Healthcare Organizations. The Official “Do 5 Not Use List”.Retrieved September 29, 2007, http://www.jointcommission.org Common Medical Abbreviations: Route Route – IM intramuscular Example: Depo-Provera ® 150 mg/mL, # 1mL 150 mg IM q 3 months – SC subcutaneous Example: Lantus 100 units/mL, # 1 vial Inject 10 units SC q hs 6 Common Medical Abbreviations: Route Route – SL sublingual (under the tongue) Example: nitroglycerin 0.4 mg SL tabs, #25 i tab SL q 5 min x 3 doses prn chest pain – PO by mouth Example: atenolol 25 mg, # 30 i tab po q am 7 Common Medical Abbreviations: Route IV p.r. p.v. intravenous per rectum per vagina A.D. right ear A.S. left ear A.U. both ear O.D. Right eye O.S. Left eye O.U. Both eyes 8 Common Medical Abbreviations: Frequency a.c. p.c. prn before meals after meals as needed; as needed for – prn pain – prn HA h.s. stat at bedtime immediately 9 Common Medical Abbreviations: Frequency q 2h every 2 hours q 4-6h every 4-6 hours b.i.d. t.i.d. q.i.d. twice a day three times a day four times a day 10 Questions? 11 Manufacturer’s Label Required Info 12 Parts of a Manufacturer’s Medication Label Generic and Trade Names National Drug Code Controlled Substances Drug Schedules Dosage Strength Precautions Administration Instructions Storage Requirements Lot Numbers and Expiration Dates 13 Generic and Trade Names FDA recognizes the United States Pharmacopoeia/National Formulary (USP/NF) as official registrar of all FDA approved drugs. USP/NF contains over 3700 medications and dietary supplements. Generic is drug’s official name in USP. Brand or Trade names that have a U.S. patent and have ® example Motrin® 14 National Drug Code All drugs assigned NDC code Helps identify the manufacture, the product, and container size. Always 11 digits. Divided into 5 -4-2 Manufacture is first 5 digits Product code is 4 Package size is 2 15 NDC 00006-0543-61 00006 is the code for manufacture. In this case Merck & Co, Inc 0543 is the specific drug in this case simvastatin generic name. 61 is the size of the bottle, in this case 60 tablets. 16 Storage, Lot Numbers and Expiration Dates Storage information (Room Temp, Refrigeration) Lot Numbers-Important for recalls Expiration Dates-can be affected if not stored properly. Other things that effect expiration dates type of container and humidity. 17 The controlled substance drug schedule There are 5 schedules Labeled with a C and roman number Which schedule is determined based on potential for dependency and abuse. The lower the number the higher the potential for dependency and abuse. Good examples on pg 83 in your text. 18 Week 2 Seminar Measurement Systems and Their Equivalents 19 Assignment Hints Show your work, so I can give partial credit Turn it in early in case you need to make corrections Don’t forget about the Math Center if you need help 20 Metric System Based on the decimal system Is the international standard for scientific and industrial measurements Used in more than 90% of developed countries 21 Three Basic Units of Measurement Weight – gram (g, gm) Volume – liter (L) Length – meter (m) 22 Common Prefixes Deci- = 0.1 (one-tenth of one unit) Centi- = 0.01 (one-hundredth of one unit) Milli- = 0.001 (one-thousandth of one unit) Micro- = (one-millionth of one unit) Kilo- = 1000 units 23 Metric Prefixes Figure 6-2. The basic units of measure–gram, liter, and meter–with prefixes indicating larger or smaller measures. Thus, deka- (“ten”) refers to ten basic units, and deci- (“tenth”) refers to one-tenth of the basic unit. Chart on page 131 24 Sliding Mnemonic Conversions Kilo 10-3 hecto 10-2 deka 10-1 EX: .0045kg<= EX: .075km <= METER(m) LITER(L) GRAM(g) <<base>> 4.5g 75m deci centi milli * * micro(µ) 101 102 103 * * 106 => 4,500mg = 4,500,000mcg (µ) =>7500cm =75,000mm Metric Rules Zero ALWAYS placed before decimal ex: 0.78 (not .78) **If not included on assignments it will be counted as incorrect Zero NEVER added to the end ex: 1.01 (not 1.0100) No fractions ex: 0.1 (not 1/10) Length Measurement 1 Meter = 39.37 inches 2.5 cm = 1 inch 1 m = 1000 mm 1 m = 100 cm 1 cm = 10 mm 27 One Meter is… = 1,000,000 micrometers 1 meter= 1000 millimeters = = = = = 100 centimeters 10 decimeters 0.1 dekameters 0.01 hectometers 0.001 Kilometers 28 Length Conversion Factors Divide if smaller unit is given and larger unit must be found Moving decimal left = divide Example: ________cm = 75 mm (smaller unit) 75 ÷ 10 = 7.5 75 mm = 7.5 cm Rule: 1 cm = 10 mm 29 Length Alternate Way 75mm =____ cm Remember 1cm = 10mm from page 133 75mm x 1cm or 75mm x 1cm 10mm 10mm mm cross each other out leaving cm 75/10= 7.5cm 30 Length Mneumonic Method 75mm=___cm K h d <MLG> d c m * * µ Start @ milli, must move decimal to the left one time to reach centi so move 75 mm to 7.5 cm Length Conversion Factors Multiply if larger unit is given and smaller unit must be found Moving decimal right = multiply Example: ________mm = 2.5 m (larger unit) 2.5 x 1000 = 2500 2.5 m = 2500 mm Rule: 1000 mm = 1 m page 133 32 Length Alternate Way 2.5m = mm 1m = 1000mm (from page 133) 2.5m x 1000mm or 2.5m x 1000mm 1m 1m The m cross each other out leaving mm 2.5 x 1000=2500mm 33 Length Mneumonic method 2.5m=____mm K h d <MLG> d c m * * µ Start @ meter (base) and move 3 decimal points to the right so 2.5m becomes 2500mm Length Conversion Factors Multiply if larger unit is given and smaller unit must be found Moving decimal right = multiply Example: ________mm =3.6 m (larger unit) Who can solve this? 35 Length Conversion Factors Multiply if larger unit is given and smaller unit must be found Moving decimal right = multiply Example: ________mm =3.6 m (larger unit) 3.6 x 1000 = 3600 3600 mm = 3.6 m 36 Length Alternate Way 3.6 m = mm Again 1m = 1000mm 3.6m x 1000mm/1m or 3.6m x 1000mm 1m The m cross each other out leaving 3.6 x 1000mm= 3600mm 37 Length Mneumonic Method 3.6m=____mm K h d <MLG> d c m * * µ Start @ meter (base) move 3 decimal spaces to the right so 3.6m becomes 3600mm’s Liter is the metric unit of volume =1,000,000microliters 1 Liter (L.) = 1,000 milliliters = 100 centiliters =10 deciliters =0.1 dekaliter =0.01 hectoliter =0.001 kiloliter 39 Volume Measurement 1 mL = 1cc 1 teaspoonful=5mL or 5cc’s 1 tablespoon=3 tsp = 15mL or 15cc’s 1 L = 32 ounces (approx) 1L = 1000 mL=1000cc 1L = 1qt (approx) 40 Metric Measure of Weight Gram =1,000,000micrograms 1 gram= 1000 mg = = = = = 100 centigrams 10 decigrams 0.1 dekagram 0.01 hectogram 0.001 kilogram 41 Most Commonly Used Milligram Gram Kilogram 1000mg (mg)=1 gram (g) 1000gms (g) = 1 kilogram (kg. or kilo) 42 Weight Measurement 1 1 1 1 kg = 2.2 pounds kg = 1000 g mg = 0.001g mg = 1000 mcg or µg 43 Weight Conversion Factors _____ mg = 8 g(larger unit) 8 X 1000 = 8000 mg 8000 mg = 8 g Rule: 1000 mg = 1 g _____ mg = 635 mcg (smaller unit) 635 ÷ 1000 = 0.635 mg 0.635 mg = 635 mcg Rule: 1 mg = 1000 mcg or µg 44 Weight Alternate Way _____ mg = 8 g Remember 1g = 1000mg Page 136 8g x 1000mg/1g or 8g x 1000mg 1g g cross each other out 8 x 1000= 8000mg _____ mg = 635 mcg 1mg =1000mcg Page 136 635mcg x 1mg/1000mcg or 635mcg x 1mg 1000mcg mcg cross each other out 635/1000= 0.635mcg 45 Weight Mneumonic Method 8g=____mg 635mcg(µ)=____mg K h d <MLG> d c m * * µ Start @ gram (base) and move 3 units to the right to get milligrams 8g to the right becomes 8000mg K h d <MLG> d c m * * µ Start @ mcg(µ) and move 3 units to the left to reach milligrams 635mcg to the left becomes 0.635mg Apothecary System Old measurement system for calculating drug orders 1 drop (gtt) of water = 1 minim (ɱ) 60 minims(=60gtts) = 1 fluid dram (fӠ) 1 grain = approximately the weight of 1 grain of wheat or rice = 60mg 47 Household System Volume – – – – 1 1 1 1 cup (c) = 8 oz pint (pt) = 2 c = 16 oz quart (qt) = 2 pt = 4 c =32 oz gallon (gal)= 4 qt= 8 pt = 16c = 128oz Weight or mass – 1 pound = 16 oz Length – 1 foot = 12 in – 1 yard = 3ft 36in 48