Week 2 Medication Orders/Rx’s chapter 5 Measurement Systems chapter 7 Pharmacology HS140/HS140h *** Christo N. Stevens, PharmD 1

(Joint Commission on Accreditation of Healthcare Organizations) JCAHO (Joint Commission on Accreditation of Healthcare Organizations) Created an Official “Do Not Use” List Created an Official “Do Not Use” List –Why?  easily misinterpreted abbreviations increased risk of errors compromised patient safety compromised patient safety  Remember “The Five Rights” … next slide 2

“The Five Rights” The Five Rights  The Five Rights  –Goal of healthcare professionals  RIGHT patient  RIGHT drug  RIGHT amount (dose)  RIGHT route  RIGHT time 2

Medication Errors Medication errors … Medication errors … who can make a medication error? who can make a medication error? –Patient –Pharmacist –Doctor –Allied Health Care workers 20

Medication Orders document generated by MD in hospital / inpatient setting for ‘in-house’ medication needs (for patient/resident) document generated by MD in hospital / inpatient setting for ‘in-house’ medication needs (for patient/resident) Cannot be taken to an outside pharmacy to be ‘filled’ Cannot be taken to an outside pharmacy to be ‘filled’ See ‘6 parts of a Medication Order’ on the next slide … See ‘6 parts of a Medication Order’ on the next slide … 5

6 parts of a Medication-Order DATE DATE PATIENT NAME (D.O.B. recommended!) PATIENT NAME (D.O.B. recommended!) DRUG NAME DRUG NAME DOSAGE or AMOUNT of medication DOSAGE or AMOUNT of medication ROUTE of administration (po, IV, etc) ROUTE of administration (po, IV, etc) TIME or FREQUENCY of administration (B.I.D., T.I.D., q4h, q12h, etc) TIME or FREQUENCY of administration (B.I.D., T.I.D., q4h, q12h, etc) 6

Written Prescriptions (Rx) For out-patient use For out-patient use legal document given by MD directly to the patient, or is called/faxed to pharmacy legal document given by MD directly to the patient, or is called/faxed to pharmacy Patient can take this to the ‘Drug Store’ Patient can take this to the ‘Drug Store’ Single-line (only 1 drug per prescription) Single-line (only 1 drug per prescription) Multiple-line (more than 1 drug written on the same prescription-blank) Multiple-line (more than 1 drug written on the same prescription-blank) 7

Common Medical Abbreviations: Route –IM=intramuscular (into muscle)  Example: Depo-Provera ® 150 mg/mL, # 1mL 150 mg IM q 3 months –SC=subcutaneous (under skin)  Example: Lantus 100 units/mL, # 1 vial Inject 10 units SC q hs 8

Common Medical Abbreviations: 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 9

Route abbreviations cont. pr = ‘per rectum’ (insert rectally) pr = ‘per rectum’ (insert rectally) RX example: Insert I suppository pr q6h prn RX example: Insert I suppository pr q6h prn Instructing the patient to… “Insert 1 suppository per rectum every 6 hours as needed” Instructing the patient to… “Insert 1 suppository per rectum every 6 hours as needed” pv = ‘per vagina’ (insert vaginally) pv = ‘per vagina’ (insert vaginally) RX example: Insert 1-gram pv qhs x 7 doses RX example: Insert 1-gram pv qhs x 7 doses instructing this patient to… “Insert 1-gram per vagina (or ‘vaginally’) at bedtime for 7 doses” instructing this patient to… “Insert 1-gram per vagina (or ‘vaginally’) at bedtime for 7 doses” 10

EYE (opthalmics)/EAR (otics) for Eye-drops, eye- ointments … for Eye-drops, eye- ointments … OD = Right-eye OS = Left-eye OU = both eyes, or ‘each’ eye For Ear-drops … For Ear-drops … AD = Right-ear AS = Left-ear AU = both ears, or ‘each’ ear 11

Common Medical Abbreviations: Frequency ac = before meals ac = before meals pc = after meals pc = after meals prn = as needed for … prn = as needed for … –prn pain –prn itching hs = at bedtime hs = at bedtime stat = immediately, now stat = immediately, now 12

Common Medical Abbreviations: Frequency q2h = every 2 hours q2h = every 2 hours q4-6h = every 4-6 hours q4-6h = every 4-6 hours b.i.d. = twice a day (‘b’ as in ‘bi-ped’) b.i.d. = twice a day (‘b’ as in ‘bi-ped’) t.i.d. = 3 times a day (‘t’ as in ‘three’) t.i.d. = 3 times a day (‘t’ as in ‘three’) q.i.d. = 4 times a day (‘q’ as in ‘quad’) q.i.d. = 4 times a day (‘q’ as in ‘quad’) 13

Required parts of a Manufacturer’s Medication Label Generic & Trade Names (if Brand-drug) Generic & Trade Names (if Brand-drug) National Drug Code (NDC#) National Drug Code (NDC#) Controlled-subst class(Drug-Schedule) Controlled-subst class(Drug-Schedule) Dosage / Strength Dosage / Strength Precautions Precautions Administration Route Administration Route Storage Requirements (temp, etc) Storage Requirements (temp, etc) Lot Numbers and Expiration-Dates Lot Numbers and Expiration-Dates 14

generic and Trade Names The generic is drug’s ‘official name’ in the USP. The generic is drug’s ‘official name’ in the USP. Brand(Trade) drugs have a U.S. patent and have the ‘®’ attached (example … Motrin® is the Brand-name, ibuprofen is generic-name) Brand(Trade) drugs have a U.S. patent and have the ‘®’ attached (example … Motrin® is the Brand-name, ibuprofen is generic-name) Brand-names --- are always Capitalized ! Brand-names --- are always Capitalized ! generic-names --- always in lower-case, and drugs in the same therapeutic class almost always end with the same ‘suffix’ (amoxicillin, penicillin, ampicillin …or lovastatin, simvastatin, etc) generic-names --- always in lower-case, and drugs in the same therapeutic class almost always end with the same ‘suffix’ (amoxicillin, penicillin, ampicillin …or lovastatin, simvastatin, etc) 15

National Drug Code All drugs are assigned an NDC# All drugs are assigned an NDC# to identify the manufacture, the product, and container-size. to identify the manufacture, the product, and container-size. Always 11 digits. Always 11 digits. Format is (5-4-2) Format is (5-4-2) first 5 = the manufacturer first 5 = the manufacturer middle 4 = product (the actual drug & strength) middle 4 = product (the actual drug & strength) Last 2 =‘Pack size’ (quantity of contents) Last 2 =‘Pack size’ (quantity of contents) 16

NDC# identifies the product’s manufacturer... This is Merck & Co, Inc identifies the product’s manufacturer... This is Merck & Co, Inc 0726 is the specific drug and strength… … this example indicates ‘Zocor-20mg’ 0726 is the specific drug and strength… … this example indicates ‘Zocor-20mg’ 54 refers to the size of the bottle, this NDC# would be found on a 30-tab bottle 54 refers to the size of the bottle, this NDC# would be found on a 30-tab bottle 17

Controlled-Substance ‘schedule’ There are 5 schedules (aka ‘classes’) There are 5 schedules (aka ‘classes’) Labeled with a ‘C’ and Roman-numeral (example ‘C-III’ = a schedule-3 drug) Labeled with a ‘C’ and Roman-numeral (example ‘C-III’ = a schedule-3 drug) ‘Schedule’ determined by a drug’s potential for dependency & abuse. ‘Schedule’ determined by a drug’s potential for dependency & abuse. The lower the number the higher the 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. Good examples on pg 83 in your text. 18

Week 2 Seminar Measurement Systems and Their Equivalents 19

Assignment Tips Show your work, so I can give partial credit ! Show your work, so I can give partial credit ! Turn in early in case you need to make corrections Turn in early in case you need to make corrections Don’t forget about the Math Center if you need help Don’t forget about the Math Center if you need help 20

Metric System Based on the decimal system Based on the decimal system the international standard for scientific and industrial measurements the international standard for scientific and industrial measurements Used in more than 90% of developed countries Used in more than 90% of developed countries 21

Three Basic Units of Measure in the Metric system Weight – gram (g, gm) Weight – gram (g, gm) Volume – liter (L) Volume – liter (L) Length – meter (m) Length – meter (m) 22

Common Prefixes Deci = 0.1 (one-tenth of one unit) Deci = 0.1 (one-tenth of one unit) Centi = 0.01 (one-hundredth of a unit) Centi = 0.01 (one-hundredth of a unit) Milli = (one-thousandth of a unit) Milli = (one-thousandth of a unit) Micro = (one-millionth of one unit) Micro = (one-millionth of one unit) Kilo = 1000 units Kilo = 1000 units 23

Metric Rules Zero ALWAYS placed before decimal ex: 0.78 (not.78) Zero ALWAYS placed before decimal ex: 0.78 (not.78) ** If not included on assignments, this may be counted as incorrect ! ** If not included on assignments, this may be counted as incorrect ! Zero NEVER added to the end Zero NEVER added to the end ex: 1.01 (not ) Do Not use fractions to express values …’one-tenth’ would be [0.1], not [1/10] Do Not use fractions to express values …’one-tenth’ would be [0.1], not [1/10]

Length Measurement 1 Meter = inches 2.5 cm = 1 inch 1 m = 1000 mm 1 m = 100 cm 1 cm = 10 mm 25

Liter the metric unit of volume =1,000,000microliters =1,000,000microliters 1 Liter = 1L = 1,000 milliliters 1 Liter = 1L = 1,000 milliliters = 100 centiliters = 100 centiliters =10 deciliters =10 deciliters =0.1 dekaliter =0.1 dekaliter =0.01 hectoliter =0.01 hectoliter =0.001 kiloliter =0.001 kiloliter 26

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) 27

GRAM - Metric Measure of Weight = 1,000,000micrograms = 1,000,000micrograms 1 gram = (1g) = 1000 mg 1 gram = (1g) = 1000 mg = 100 centigrams = 100 centigrams = 10 decigrams = 10 decigrams = 0.1 dekagram = 0.1 dekagram = 0.01 hectogram = 0.01 hectogram = kilogram = kilogram 28

Most Common GRAM-based units Milligram (mg) Milligram (mg) Gram (g) Gram (g) Kilogram (kg) Kilogram (kg) 1000 mg =1 g 1000 mg =1 g 1000 gm = 1 kilogram (kg or kilo) 1000 gm = 1 kilogram (kg or kilo) 29

Weight Measurement 1 kg = 2.2 pounds 1 kg = 1000 g 1 mg = 0.001g 1 mg = 1000 mcg or µg 30

Apothecary System Old measurement system for calculating drug orders Old measurement system for calculating drug orders 1 drop (gtt) of water = 1 minim ( ɱ ) 1 drop (gtt) of water = 1 minim ( ɱ ) 60 minims(60gtts) = 1 fluid dram (f Ӡ ) 60 minims(60gtts) = 1 fluid dram (f Ӡ ) 1 grain = approximately the weight of 1 grain of wheat or rice = 60mg … 1 grain = approximately the weight of 1 grain of wheat or rice = 60mg … Bottom-line! 1-grain = 60-mg Bottom-line! 1-grain = 60-mg Grain apothecary examples: [gr i = 60mg] or [gr ii = 120mg] or [gr ss = 30mg] or [gr iss = 90mg] …’ss’ means ‘1/2’ !! 31

Household System Volume Volume –1 cup (c) = 8 oz –1 pint (pt) = 2 c = 16 oz –1 quart (qt) = 2 pt = 4 c =32 oz –1 gallon (gal)= 4 qt= 8 pt = 16c = 128oz Weight or mass Weight or mass –1 pound = 16 oz Length Length –1 foot = 12 in –1 yard = 3ft = 36in 32