1. Week 2- Medication Orders and Measurement Systems Jack Lazarre, Pharm.D. 1

2. Medication Order Issues Are you expected to know everything? Are you expected to know everything? –No healthcare professional is Tip Tip  Obtain a good, current reference  When in doubt ask –No silly questions related to patient safety 2

3. (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” 3

4. “Do Not Use” List Examples DON’T DON’T 1. 1. “u” or “IU” for units 2. 2. “q.d." "qd" "Q.D." "QD“ 3. 3. “Q.O.D.” DO DO 1. 1. Spell out the word “units” 2. 2. Spell out the word “daily” 3. 3. Spell out “every other day” The Joint Commission on Accreditation of Healthcare Organizations. The Official “Do Not Use List”.Retrieved September 29, 2007, http://www.jointcommission.org http://www.jointcommission.org 4

5. “Do Not Use” List Examples DON’T DON’T 1. 1. Trailing zero – – “5.0 mg” 1. 1. Decimal point without a leading zero – –“.5” can be mistaken for “5” DO DO 1. 1. Avoid the use of a zero after a decimal point –“5” 2. 2. Use a leading zero before a decimal –“0.5” The Joint Commission on Accreditation of Healthcare Organizations. The Official “Do Not Use List”.Retrieved September 29, 2007, http://www.jointcommission.org http://www.jointcommission.org 5

6. Common Medical Abbreviations: Route Route Route –IMintramuscular  Example: Depo-Provera ® 150 mg/mL, # 1mL 150 mg IM q 3 months –SCsubcutaneous  Example: Lantus 100 units/mL, # 1 vial Inject 10 units SC q hs 6

7. Common Medical Abbreviations: Route Route Route –SLsublingual (under the tongue)  Example: nitroglycerin 0.4 mg SL tabs, #25 i tab SL q 5 min x 3 doses prn chest pain –POby mouth  Example: atenolol 25 mg, # 30 i tab po q am 7

8. Common Medical Abbreviations: Route IVintravenous IVintravenous p.r.per rectum p.r.per rectum p.v.per vagina p.v.per vagina O.D.Right eye O.S.Left eye O.U.Both eyes A.D.right ear A.S.left ear A.U.both ear 8

9. Common Medical Abbreviations: Frequency a.c.before meals a.c.before meals p.c.after meals p.c.after meals prnas needed; prnas needed; as needed for –prn pain –prn HA h.s.at bedtime h.s.at bedtime statimmediately statimmediately 9

10. Common Medical Abbreviations: Frequency q 2hevery 2 hours q 2hevery 2 hours q 4-6hevery 4-6 hours q 4-6hevery 4-6 hours b.i.d.twice a day b.i.d.twice a day t.i.d.three times a day t.i.d.three times a day q.i.d.four times a day q.i.d.four times a day 10

11. Questions? 11

12. Required Info Manufacturer’s Label 12

13. Parts of a Manufacturer’s Medication Label Generic and Trade Names Generic and Trade Names National Drug Code National Drug Code Controlled Substances Drug Schedules Controlled Substances Drug Schedules Dosage Strength Dosage Strength Precautions Precautions Administration Instructions Administration Instructions Storage Requirements Storage Requirements Lot Numbers and Expiration Dates Lot Numbers and Expiration Dates 13

14. Generic and Trade Names FDA recognizes the United States Pharmacopoeia/National Formulary (USP/NF) as official registrar of all FDA approved drugs. 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. USP/NF contains over 3700 medications and dietary supplements. Generic is drug’s official name in USP. Generic is drug’s official name in USP. Brand or Trade names that have a U.S. patent and have ® example Motrin® Brand or Trade names that have a U.S. patent and have ® example Motrin® 14

15. National Drug Code All drugs assigned NDC code All drugs assigned NDC code Helps identify the manufacture, the product, and container size. Helps identify the manufacture, the product, and container size. Always 11 digits. Always 11 digits. Divided into 5 -4-2 Divided into 5 -4-2 Manufacture is first 5 digits Manufacture is first 5 digits Product code is 4 Product code is 4 Package size is 2 Package size is 2 15

16. NDC 00006-0543-61 00006 is the code for manufacture. In this case Merck & Co, Inc 00006 is the code for manufacture. In this case Merck & Co, Inc 0543 is the specific drug in this case simvastatin generic name. 0543 is the specific drug in this case simvastatin generic name. 61 is the size of the bottle, in this case 60 tablets. 61 is the size of the bottle, in this case 60 tablets. 16

17. Storage, Lot Numbers and Expiration Dates Storage information (Room Temp, Refrigeration) Storage information (Room Temp, Refrigeration) Lot Numbers-Important for recalls Lot Numbers-Important for recalls Expiration Dates-can be affected if not stored properly. Expiration Dates-can be affected if not stored properly. Other things that effect expiration dates type of container and humidity. 17

18. The controlled substance drug schedule There are 5 schedules There are 5 schedules Labeled with a C and roman number Labeled with a C and roman number Which schedule is determined based on potential for dependency and abuse. Which schedule is determined based on potential for dependency and 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

19. Week 2 Seminar Measurement Systems and Their Equivalents 19

20. Assignment Hints Show your work, so I can give partial credit Show your work, so I can give partial credit Turn it in early in case you need to make corrections Turn it 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

21. Metric System Based on the decimal system Based on the decimal system Is the international standard for scientific and industrial measurements Is 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

22. Three Basic Units of Measurement Weight – gram (g, gm) Weight – gram (g, gm) Volume – liter (L) Volume – liter (L) Length – meter (m) Length – meter (m) 22

23. Common Prefixes Deci- = 0.1 (one-tenth of one unit) Deci- = 0.1 (one-tenth of one unit) Centi- = 0.01 (one-hundredth of one unit) Centi- = 0.01 (one-hundredth of one unit) Milli- = 0.001 (one-thousandth of one unit) Milli- = 0.001 (one-thousandth of one unit) Micro- = (one-millionth of one unit) Micro- = (one-millionth of one unit) Kilo- = 1000 units Kilo- = 1000 units 23

24. 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 24

25. Sliding Mnemonic Conversions Kilo hecto deka METER(m) deci centi milli * * micro(µ) LITER(L) LITER(L) GRAM(g) GRAM(g) 10 -3 10 -2 10 -1 > 10 1 10 2 10 3 * * 10 6 EX:. 0045kg 4,500mg = 4,500,000mcg ( µ) EX:.075km 7500cm =75,000mm

26. 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 it will be counted as incorrect ** If not included on assignments it will be counted as incorrect Zero NEVER added to the end Zero NEVER added to the end ex: 1.01 (not 1.0100) No fractions ex: 0.1 (not 1/10) No fractions ex: 0.1 (not 1/10)

27. Length Measurement 1 Meter = 39.37 inches 2.5 cm = 1 inch 1 m = 1000 mm 1 m = 100 cm 1 cm = 10 mm 27

28. One Meter is… = 1,000,000 micrometers = 1,000,000 micrometers 1 meter= 1000 millimeters 1 meter= 1000 millimeters = 100 centimeters = 10 decimeters = 0.1 dekameters = 0.01 hectometers = 0.001 Kilometers 28

29. Length Conversion Factors Divide if smaller unit is given and larger unit must be found Divide if smaller unit is given and larger unit must be found Moving decimal left = divide Moving decimal left = divideExample: ________cm = 75 mm (smaller unit) 75 ÷ 10 = 7.5 75 mm = 7.5 cm Rule: 1 cm = 10 mm 29

30. Length Alternate Way 75mm =____ cm 75mm =____ cm Remember 1cm = 10mm from page 133 Remember 1cm = 10mm from page 133 75mm x 1cm or 75mm x 1cm 10mm10mm 75mm x 1cm or 75mm x 1cm 10mm10mm mm cross each other out leaving cm mm cross each other out leaving cm 75/10= 7.5cm 75/10= 7.5cm 30

31. Length Mneumonic Method 75mm=___cm 75mm=___cm K h d d c m * * µ K h d 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 Start @ milli, must move decimal to the left one time to reach centi so move 75 mm to 7.5 cm

32. Length Conversion Factors Multiply if larger unit is given and smaller unit must be found Multiply if larger unit is given and smaller unit must be found Moving decimal right = multiply Moving decimal right = multiplyExample: ________mm = 2.5 m (larger unit) 2.5 x 1000 = 2500 2.5 m = 2500 mm Rule: 1000 mm = 1 m page 133 32

33. Length Alternate Way 2.5m = mm 2.5m = mm 1m = 1000mm (from page 133) 1m = 1000mm (from page 133) 2.5m x 1000mm or 2.5m x 1000mm 2.5m x 1000mm or 2.5m x 1000mm 1m 1m The m cross each other out leaving mm The m cross each other out leaving mm 2.5 x 1000=2500mm 2.5 x 1000=2500mm 33

34. Length Mneumonic method 2.5m=____mm 2.5m=____mm K h d d c m * * µ K h d d c m * * µ Start @ meter (base) and move 3 decimal points to the right so 2.5m becomes 2500mm Start @ meter (base) and move 3 decimal points to the right so 2.5m becomes 2500mm

35. Length Conversion Factors Multiply if larger unit is given and smaller unit must be found Multiply if larger unit is given and smaller unit must be found Moving decimal right = multiply Moving decimal right = multiplyExample: ________mm =3.6 m (larger unit) Who can solve this? 35

36. Length Conversion Factors Multiply if larger unit is given and smaller unit must be found Multiply if larger unit is given and smaller unit must be found Moving decimal right = multiply Moving decimal right = multiplyExample: ________mm =3.6 m (larger unit) 3.6 x 1000 = 3600 3600 mm = 3.6 m 36

37. Length Alternate Way 3.6 m = mm 3.6 m = mm Again 1m = 1000mm Again 1m = 1000mm 3.6m x 1000mm/1m or 3.6m x 1000mm/1m or 3.6m x 1000mm 3.6m x 1000mm1m The m cross each other out leaving The m cross each other out leaving 3.6 x 1000mm= 3600mm 3.6 x 1000mm= 3600mm 37

38. Length Mneumonic Method 3.6m=____mm 3.6m=____mm K h d d c m * * µ K h d d c m * * µ Start @ meter (base) move 3 decimal spaces to the right so 3.6m becomes 3600mm’s Start @ meter (base) move 3 decimal spaces to the right so 3.6m becomes 3600mm’s

39. Liter is the metric unit of volume =1,000,000microliters =1,000,000microliters 1 Liter (L.) = 1,000 milliliters 1 Liter (L.) = 1,000 milliliters = 100 centiliters =10 deciliters =0.1 dekaliter =0.01 hectoliter =0.001 kiloliter 39

40. 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) 40

41. Metric Measure of Weight Gram =1,000,000micrograms =1,000,000micrograms 1 gram= 1000 mg 1 gram= 1000 mg = 100 centigrams = 10 decigrams = 10 decigrams = 0.1 dekagram = 0.01 hectogram = 0.001 kilogram 41

42. Most Commonly Used Milligram Milligram Gram Gram Kilogram Kilogram 1000mg (mg)=1 gram (g) 1000mg (mg)=1 gram (g) 1000gms (g)= 1 kilogram (kg. or kilo) 1000gms (g)= 1 kilogram (kg. or kilo) 42

43. Weight Measurement 1 kg = 2.2 pounds 1 kg = 1000 g 1 mg = 0.001g 1 mg = 1000 mcg or µg 43

44. 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 44

45. 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 1mg =1000mcg Page 136 635mcg x 1mg/1000mcg or 635mcg x 1mg/1000mcg or 635mcg x 1mg 1000mcg 1000mcg mcg cross each other out mcg cross each other out 635/1000= 0.635mcg 635/1000= 0.635mcg 45

46. Weight Mneumonic Method 8g=____mg 8g=____mg K h d d c m * * µ K h d d c m * * µ Start @ gram (base) and move 3 units to the right to get milligrams Start @ gram (base) and move 3 units to the right to get milligrams 8g to the right becomes 8000mg 8g to the right becomes 8000mg 635mcg( µ )=____mg 635mcg( µ )=____mg K h d d c m * * µ K h d d c m * * µ Start @ mcg(µ) and move 3 units to the left to reach milligrams Start @ mcg(µ) and move 3 units to the left to reach milligrams 635mcg to the left becomes 0.635mg 635mcg to the left becomes 0.635mg

47. 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 47

48. 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 48