1. 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.

2. 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

3. 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.

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

5. 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

6. Brand name and generic names

7. Brand and Generic Names
Used with permission from Aventis Pharmaceuticals.

8. Locate Generic Name
Used with permission from Abbott Laboratories.

9. 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.

10. 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

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

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

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

15. 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 mg per 5 mL

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

17. Locate Supply Dosage

18. Locate Supply Dosage

19. 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

20. 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.

21. 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

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

23. 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

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

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

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

27. 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

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

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

30. 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

31. 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
Akin to people having a ss number

32. 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

33. 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

34. 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

35. 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,

36. Other Parts of Label
Manufacturer
National Drug Code
Bar code

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

38. 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

39. 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!

40. 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

41. Review set 20