1. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 9 Parenteral Medication Labels and Dosage Calculation

2. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Parenteral Routes IV –Most common IM Subcutaneous –Second most common Intradermal –Least common

3. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Packaging Parenteral medications available in ampules, vials, prefilled syringes, bag solutions, and bottled solutions

4. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. IM Solutions Manufactured so average adult dosage contained in volume between 0.5 mL and 3 mL Most dosages prepared using 3 mL syringe

5. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Subcutaneous Solutions Manufactured so average adult dosage contained in volume between 0.5 mL and 1 mL Most dosages prepared using 3 mL or TB syringe

6. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. IV Medication Preparation Administration usually two-step procedure: 1.Prepare dosage 2.Dilute in IV fluids

7. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Solution Labels Metric/SI examples: –Morphine sulfate 4 mg/mL –Digoxin 75 mcg/mL –Cefazolin 1 gram/50 mL

8. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Solution Labels Percent examples: –1% lidocaine –10% calcium gluconate –0.45% sodium chloride

9. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Solution Labels Ratio examples: –5000 : 1 heparin –2500 : 1 heparin –1000 : 1 epinephrine

10. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Solution Labels International unit examples: –Heparin: 5000 international units –Factor VIII: 4550 international units –Factor IX: 2300 international units mEq examples: –20 mEq potassium chloride (KCl) –50 mEq sodium bicarbonate (NaHCO 3 )

11. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Safety Point Labels of most parenteral solutions quite small –Read with particular care

12. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Example 1 Prescription for atropine 1/150 grains subcutaneously Atropine vial labeled 0.4 mg/mL How many mL should be administered subcutaneously?

13. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Example 1 Convert 1/150 grains to 0.4 mg Use basic formula

14. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Example 2 Prescription for heparin 5,000 units subcutaneously Heparin vial labeled 10,000 : 1 mL heparin How many mL should be administered subcutaneously?

15. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Example 2 Use basic formula

16. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Example 3 Prescription for morphine sulfate 2 mg IV Morphine sulfate prefilled syringe contains 4 mg/mL How many mL should be administered intravenously?

17. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Example 3 Use basic formula

18. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Example 4 Prescription for promethazine sulfate 25 mg IV bolus Promethazine sulfate vial labeled 25 mg/mL

19. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Example 4 IV drug resource states each 12.5 mg of promethazine sulfate should be diluted with 5 mL normal saline for injection prior to administration via IV bolus How many total fluid and medication bolus mL should be administered intravenously?

20. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Example 4 Each 12.5 mg requires 5 mL normal saline dilution To dilute 25 mg requires 10 mL of normal saline 10 mL normal saline + 1 mL (25 mg) medication = 11 mL total volume

21. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Example 5 Prescription for 2550 international units Factor IX concentrate intravenously each day Pharmacy supplies Factor IX in concentration of 250 international units/5 mL How many mL should be administered per intravenous bolus?

22. Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Example 5 Use basic formula