Transcript Week 2- Medication Order Reminders

Week 2Medication Orders
and
Measurement Systems
Jack Lazarre, Pharm.D.
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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”
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“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
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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
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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
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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
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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
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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
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Questions?
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Manufacturer’s Label
Required Info
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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

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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®

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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

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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.

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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.

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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.

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Week 2 Seminar
Measurement Systems and Their Equivalents
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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

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Metric System
Based on the decimal system
 Is the international standard for
scientific and industrial measurements
 Used in more than 90% of developed
countries

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Three Basic Units of
Measurement

Weight – gram (g, gm)

Volume – liter (L)

Length – meter (m)
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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

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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
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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
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One Meter is…
= 1,000,000 micrometers

1 meter= 1000 millimeters
=
=
=
=
=
100 centimeters
10 decimeters
0.1 dekameters
0.01 hectometers
0.001 Kilometers
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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
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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

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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
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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
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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?
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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
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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
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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
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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)
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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
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Most Commonly Used
Milligram
 Gram
 Kilogram
 1000mg (mg)=1 gram (g)
 1000gms (g) = 1 kilogram (kg. or kilo)

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Weight Measurement
1
1
1
1
kg = 2.2 pounds
kg = 1000 g
mg = 0.001g
mg = 1000 mcg or µg
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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
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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
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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

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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
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