Understanding Drug Labels Chapter 8 Understanding Drug Labels SHOW CLASS ARTICLE MED ERROR ASK: what do you think is part of a drug label? Part of the drug order prescribes how much of a drug the pt is to receive. The nurses prepares the order from the drug on hand. The drug label tells how the available drug is supplied.

Understanding Drug Labels Recognize pertinent information on drug labels, including: Drug form Dosage strength Supply dosage or concentration Total volume of drug container Administration route Expiration date STRENGTH=weight of the drug or amount in a specific UNIT

Understanding Drug Labels You must also: Differentiate between brand and generic names of drugs. Find the directions for mixing or preparing the supply dosage of drugs, as needed. Recognize and follow drug alerts. Locate the lot or control number, National Drug Code, barcode symbols, and controlled substance classifications. Determine if containers are for single-dose or multidose use. Identify combination drugs. Describe supply dosage expressed as a ratio or percent.

Drug Names Brand, trade, and proprietary Generic Manufacturer’s name for drug Generic Established, nonproprietary name Tylenol is brand name for acetominophen

Brand and Generic Names Brand name usually most prominent Generic name must be on all drug labels (by law) Nurses must cross-check medications to prevent errors especially when only the generic name is on label

Brand name and generic names

Brand and Generic Names Used with permission from Aventis Pharmaceuticals.

Locate Generic Name Used with permission from Abbott Laboratories.

Locate Brand and Generic Name BE AWARE! Generic equivalents of many brand name drugs are ordered as substitutes or allowed by the prescribing practioner. Because ONLY the GENERIC name appears on the label, nureses need to cross-check all medications.to be sure the right medication is identified. Copyright Pfizer Inc. Reproduced with permission.

Dosage Strength Dosage weight or amount of drug provided in specific unit of measurement LOOK on page 161 at the top Some drugs such as Penicillin V potassium have two different but equivalent dosage strengths. Pen V potassium has a dosage strength of 250 mg (per tab) or 400,000 units per tab. The prescriber may order using either measurement

Locate Dosage Strength Image courtesy of Baxter Healthcare Corporation. All rights reserved.

Form Structure and composition of drug Solid forms for oral use Liquid, powder, suspension forms for oral use Injectable Suppositories Creams Patches

Locate Form Copyright Pfizer Inc. Reproduced with permission. Bottom of page 161 Copyright Pfizer Inc. Reproduced with permission.

Supply Dosage Both dosage strength and form Dosage per tablet Dosage per milliliter (liquid medication) It is read: “X amount of medication per some unit of measurement” For example: 10 mg per tablet or 250 mg per 5 mL

Locate Supply Dosage Image courtesy of Baxter Healthcare Corporation. All rights reserved.

Locate Supply Dosage

Locate Supply Dosage

Supply Dose Safety concerns with high-risk medications have led to a new way to express the supply dosage for single- and multiple-dose injectable drug products. To prevent too large a dose, dosage is displayed based on the total amount in the container with the amount per mL printed directly below in smaller print. Supply Dosage page 162….Compare Heparin and Nubain labels and the DIFFERENCE!! read the USP issued requirement 2009

Supply Dose Otherwise, the label provides the total volume per container, but not the supply dosage. Until manufacturers comply by revising all medication labels and the supply of older labels is exhausted, extreme caution must be taken when locating the dosage strength.

Total Volume Full quantity contained in package, bottle or vial tablets and solids = total number of items contained in package, bottle, or vial Liquids = total fluid volume Examples on page 163

Locate Volume Image courtesy of Baxter Healthcare Corporation. All rights reserved.

2009 FDA requirement: Strength per total volume be prominent on the label of both single and multi-vial doses of injectable product labels Followed in close proximity by the strength per mL Page 162 show example of INAPSINE

Administration Route Site of body or method of drug delivery Oral Unless specified, tablets, capsules, and caplets intended for oral use Enteral Sublingual Injection

Administration Route Site of body or method of drug delivery Otic Optic Topical Rectal

Locate Administration Route Image courtesy of Baxter Healthcare Corporation. All rights reserved.

Label Alerts Warnings or special alerts Manufacturers may print warnings Pharmacists may issue special alerts E.g., refrigerate at all times, keep in a dry place, replace cap tightly, protect from light, shake well before dispensing… Example page 164

Expiration Date Check prior to administration If expired, discard or return to pharmacy

Locate Expiration Date Page 165 bottom Used with permission from Abbott Laboratories. 29

Lot or Control Numbers Required by Federal law Important if drug is recalled for damage or tampering Quickly identifies particular group of medication packages This has been invaluable for vaccine and over the counter medication recalls

National Drug Code (NDC) Federal law requires every prescription med to have a unique ID number Printed on every manufacturer’s label Printed with the letters “NDC” followed by three groups of numbers Page 166-67 Akin to people having a ss number

Controlled Substance Schedule Classifies drugs according to potential for use and abuse Schedule I Highest potential for abuse Schedule V Lowest potential for abuse The Controlled Substances Act passed in 1971 PURPOSE: to improve regulation of the Production , Distribution and Dispensing of controlled substances SCHEDULE 1 DRUGS (heroin, LSD SCHEDULE 2 DRUGS(ms, dilaudid, Demerol, oxycontin) SCHEDULE 3 DRUGS(steroids, lowdose codeine, lowdose hydrocodone based opiods. Schedule 4 DRUGS (XANAX, clonipin, Ativan, valium, halcion SCHEDULE V DRUGS: COUGH SYRUPS, MEDS W/small amts of codiene

Official Lists of Approved Drugs 2 official national lists of approved drugs USP (UNITED STATES PHARMACOPEIA) NF (NATIONAL FORMULARY) Placed after generic name of the drug Do not mistake for other drug specific labels Middle page 167 for example

Unit or Single-Dose Labels Dose strength understood as “per one” Some medications are prepared and packaged as a single dose. The major difference is that the label WOULD NOT show total volume or amount because the the volume or amount is 1 Example bottom page 167

Combination Drugs Different substances combined Two or more drugs in one form Usually prescribed by number of tablets, capsules, or milliliters Not dosage strength Page 168 top Other examples besides pain medication are antibiotics, bp meds,

Other Parts of Label Manufacturer National Drug Code Bar code

Locate Bar Code Used with permission from Abbott Laboratories Have all students write down 6 medication rights Used with permission from Abbott Laboratories 37

Supply Dosage Expressed as a Ratio or Percent RULE: Ratio solutions express the number of grams of the drug per total milliliters of solution. Percentage (%) solutions express the number of grams of the drug per 100 milliliters of solution Examples page 168

Checking Labels Six Rights of medication administration: Right patient Right drug Right amount Right route Right time Right documentation To be absolutely sure that the patient receives the right drug, YOU must check the label 3 times!

Checking Labels Check drug label three times before administering a medication to a patient: Against medication order and the MAR Before preparing medication After preparing medication but before administering it It is important to always practice the 6 Rights of Medication Administration AND to be absolutely sure the pt receives the right drug, WE must CHECK THE LABEL OF THE MEDICATION 3 TIMES!! Can explain an example with meds from page 170

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