Chapter 13 Oral Dosages PowerPoint® Presentation to accompany:

Chapter 13 Oral Dosages PowerPoint® Presentation to accompany: Math and Dosage Calculations for Healthcare Professionals Fourth Edition Booth, Whaley, Sienkiewicz, and Palmunen

Learning Outcomes 13.1 Demonstrate administration of solid oral medications. 13.1a. Calculate dosages for solid oral medications. 13.1b. Explain principles related to administration of solid oral medications.

Learning Outcomes 13.2 Demonstrate administration of liquid oral medications. 13.2a. Calculate dosages for liquid oral medications. 13.2b. Explain principles related to administration of liquid oral medications.

Key Terms Caplet Capsule Enteric-coated Gelcap Reconstitution Scored
Spansules Sustained release Tablet Caplets – similar to tablets; oval-shaped with a special coating that makes them easy to swallow Enteric-coated – covered with a substance that dissolves only in an alkaline environment, such as the small intestine Gelcap – medication usually liquid in a gelatin capsule that should not be opened Capsulesm – usually oval-shaped gelatin shells that contain medication in powder or granule form Reconstitution – the mixing of a liquid with a powder Scored – made with a line (score) so that they can be divided when smaller doses are ordered Spansules – special capsules that contain granules of medication with different coatings that delay release of some of the medication Sustained-release – characterized by the slow release of a drug into the bloodstream over a period of several hours Tablet – the most common form of solid oral medication; combines an amount of drug with inactive ingredients such as starch or talc to form a solid disk or cylinder that is convenient for swallowing

Introduction You will apply:
the simple calculation methods learned in Chapter 12 to oral dosages; the principles of label reading learned in Chapter 10. Calculation Methods Proportion Dimensional Analysis Formula method Using steps Convert Calculate Think!…Is It Reasonable? Label information Drug name Form of the drug Dosage strength Total amount in the container Warnings Route of administration Storage requirements Manufacturing information

Remember that excellence is a must with dosage calculations.
Introduction (cont.) Use the method of calculation that you have chosen. Remember that excellence is a must with dosage calculations.

Oral Solid Medications
Solid oral medications come in several forms. Tablets Caplets Capsules Gelcaps Learning Outcome: 13.1 Demonstrate administration of solid oral medications.

Oral Solid Medications (cont.)
Tablets Combination of an amount of drug with inactive ingredients Administration forms Oral (swallow) Sublingual Buccal Chewable Dissolvable Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Tablets are the most common form of oral solid medication. The inactive ingredient in tablets may be a starch or talc. The combination is formed into a solid disk or cylinder. Administration form may be sublingual – under the tongue. Administration form may be buccal – between cheek and gum. Some tablets can be dissolved in a liquid for drinking. Check the label for correct method of administration.

Tylenol caplets 500 mg Caplets Oval-shaped Made with a special coating that makes them easier to swallow Learning Outcome: 13.1 Demonstrate administration of solid oral medications.

Capsules Oval-shaped gelatin shells containing medication in powder or granule form Learning Outcome: 13.1 Demonstrate administration of solid oral medications. The shell is usually two pieces that fit together that can be separated to remove the medication if the patient cannot swallow the capsule.

Gelcaps A liquid medication in a gelatin shell Not designed to be opened Learning Outcome: 13.1 Demonstrate administration of solid oral medications.

Scored tablets Score allows the tablet to be divided when smaller doses are ordered. Most often, scored tablets divide into halves. Some divide into thirds or quarters. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Medication is evenly distributed throughout the tablet. Breaking scored tables is not optimal practice. Determine if another dosage is available before breaking scored tablets.

Calculating Dosages – Oral Solid Medications
Rule 13-1 Always question and/or verify when your calculation indicates to give a portion of a tablet when the tablet is not scored. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications. Never attempt to break a tablet that is not scored.

Calculating Dosages – Oral Solid Medications (cont.)
Rule 13-2 Question and recheck any calculation that indicates that you should administer more than three tablets or capsules. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications.

Rule Follow these steps when determining the amount of medication to administer to a patient: Step A Convert Step B Calculate Step C Think! Is It Reasonable? Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications. If necessary, convert the desired dose to the same unit of measurement as the dose on hand. Perform dosage calculation using method of choice: proportion; dimensional analysis; or formula method. If necessary, recheck calculation.

The order is to give the patient 15 mg mirtazapine PO now. On hand: 30 mg scored tablets Calculate the correct amount of medication to administer using method of choice. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications.

H = 30 mg ; Q = 1 scored tablet; D = 15 mg Step A Convert No conversion is necessary. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications. Step A Dose ordered is the same unit of measure as dose ordered, so no conversion is necessary.

Step B Proportion H/Q = D/A or H:Q = D:A 30 mg/1 tab = 15 mg/A 30 x A = 1 tab x 15 30A/30 = 15 tab/30 A = 0.5 tab = 1/2 tab Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications.

Step B Dimensional analysis A = Q/H x D/1 A tab = 1 tab/30 mg x15 mg/1 A tab = 15 tab/30 A tab = 0.5 tab = 1/2 tablet Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications.

Step B Formula Method 15mg/30 mg x 1 tab = A 15 tab/30 = A 0.5 tab = 1/2 tablet = A A xQ = H D Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications.

Step C Think! Is It Reasonable? 15 mg is one-half of 30 mg, so 1/2 tablet is an appropriate answer. Tablets are scored, so 1/2 tablet can be given. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications.

Error Alert Observe patients as they take their medications. Leaving medications at the bedside leads to errors. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Reason for errors: Patients may forget to take their medications or may take them at wrong time. Medications may be spilled or dropped. The patient may have difficulty swallowing the medications leading to possible aspiration.

Crushing Tablets or Opening Capsules
Who benefits? Patients who have difficulty swallowing pills Patients who have tube feedings Check the policy May need physician order first Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications.

Crushing Tablets or Opening Capsules (cont.)
When mixing with food prepare tablet or capsule; mix with soft foods or liquids. Check for interactions before mixing. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Be sure there are not interactions with food before mixing. Example: Tetracycline should not be given with foods containing milk, antacids, or vitamin and mineral supplements.

Some Common Food and Drug Interactions
Antipsychotics Coffee and tea Reduced effectiveness of drug Bronchodilators Caffeine Stimulation of the nervous system CNS depressants Black cohosh, ginseng, kava kava, St. John’s wort, valerian, ETOH Intensified sedative effects of drug Erythromycin Acidic fruits, juices, carbonated beverages Decreased antimicrobial activity Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications.

Some Common Food and Drug Interactions (cont.)
Ferrous sulfate Tea Decreased absorption Haloperidol Coffee and tea Insulin Coffee Stimulated excretion MAO inhibitors Foods with tryamine (hard cheeses, chocolate, red wine, and beef or chicken liver) Headache, nosebleed, chest pain, severe hypertension Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications.

Some Common Food and Drug Interactions (cont.)
Tetracyclines Dairy products Reduced effectiveness of the drug Antihistamines, cholesterol lowering agents, calcium channel blockers Grapefruit and grapefruit juice Muscle aches, fatigue, increase in side effects Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications.

Tube feedings Dissolve the crushed tablet or opened capsule in a small amount of warm water. If medication cannot be crushed check for an alternative form; ask the physician to change the order. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Warm water (not hot) helps the medication dissolve better.

Enteric-coated tablets: deliver medication that would be destroyed by the stomach acid or that could injure the stomach lining; must never be crushed, broken, or chewed. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Coating dissolves only in an alkaline environment such as the small intestine.

Sustained-Release Medications Drug is released slowly into the bloodstream. Do not crush or dissolve – this allows too much medication to be absorbed at one time. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. If scored, break at scored line; otherwise, do not break it.

Spansules contain granules of medication with different coatings that delay release of some of the medication; may be opened and the granules gently mixed with soft food. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Do not crush or dissolve the granules.

Rule 13-4 To prevent an incorrect dose of medication, do not crush or otherwise alter any of the following: enteric-coated tablets; sustained-release forms of medication; any tablet with a hard shell or coating; Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications.

Rule 13-4 (cont.) any tablet with layers or speckles of different colors; tablets for sublingual or buccal use; capsules with seals that prevent separating the two parts. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications.

Indication of sustained-release drugs: -Bid LA Tempule -Dur CR Chronotab Plateau Cap XL Repetab Span Sequel Tembid SA Spansule SR Extentab Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Drugs that must not be crushed / dissolved

Indication of enteric-coated drugs: EC Enseal Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Drugs that must not be crushed / dissolved

Patient Education Determining how many pills to take
Perform necessary calculations first. Determining whether or not to take with food Drink at least 8 oz of water with any medication. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Know how many pills the patient will have to take prior to starting education process.

Patient Education (cont.)
Divided tablets Pharmacist can provide service of dividing the tablets. If patient will do dividing himself, he should: wash his hands; break tablet along scored line; use a knife or pill cutter. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. If the patients will be dividing the tablets, provide a demonstration. Grasp the tablet with the scored line between your fingers. Exert pressure in the same direction—downward or upward—with both hands, until the tablet breaks along the scored line. You may use a knife or pill cutter to break the tablet. Place the tablet on a clean surface, place the blade in the scored line, and press directly downward until the tablet breaks. (Cutting on a slice of bread prevents the halves of the pills from “flying” away.)

If patients have difficulty swallowing, they can drink water before taking pills; place whole tablet or capsule in food; crush tablets. Place between two spoons. Use pill crusher. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Drinking water first moistens the mouth. The pill will go down when the food is swallowed. Note: Also tell patients which foods should not be used. Warn patients not to crush any medication without first checking with the pharmacist or physician.

Practice Ordered: Ploglitazone HCl 45 mg po
On hand: see label (unscored tablet) What is the amount to administer? What action should you take? Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. H = 30 mg Q = 1 tablet D = 45 mg Step A No conversion is needed. Step B 45mg / 30mg x 1 tab = A [cancel units (mg)] 1.5 x 1 tab = A = 1.5 tab Step C Dose ordered is 1.5 times greater than dose on hand, so 1.5 tab is reasonable. Since tablets are not scored, you should check to see if another dosage strength is available. If not, you must contact the physician to change the order. ANSWER: 1 1/2 tablet ANSWER: Do not break tablet; check for another dose; contact physician.

Practice Ordered: Alpraxolam 1.5 mg po q 6 h On hand: see label (scored into fourths) What is the amount to administer? What action do you take? ANSWER: ¾ tablet Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Step A No conversion is needed. Step B H = 2 mg Q = 1 tablet (scored) D = 1.5 mg 1.5mg/2 mg x 1 tablet = A [cancel units (mg)] 0.75 x 1 tab = tab = 3/4 A Step C Dose ordered is greater than half but not as much as dose on hand, so 3/4 tablet is reasonable. Carefully break tablet in half at score, and then break one of halves in half again. Administer the half and the quarter sections of the tablet. ANSWER: break tablet and administer 3/4 tablet

Liquid Oral Medications
Greater range of dosages possible Easier to swallow For children For the elderly Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Also easily administered through feeding tubes

Liquid Oral Medications (cont.)
May be less stable so provided in powdered form See directions for reconstitution Label Package insert Follow requirements for refrigeration Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2b Explain principles related to administration of liquid oral medications. Because they rapidly lose their power once they are mixed into a solution, they will have to be reconstituted, or mixed with a liquid, before they can be administered. Many liquid medications require refrigeration. This is true of antibiotics in particular.

Rule Reconstituting Liquid Medications: Use only the liquid specified on label. Use the exact amount of liquid specified. Check the label – medication may need to be shaken before administering. Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2b Explain principles related to administration of liquid oral medications. Read the drug label!

Rule (cont.) Check the label – is refrigeration of reconstituted medication needed? Write on the label Date and time of reconstitution Your initials Dosage strength Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2b Explain principles related to administration of liquid oral medications. Check label to determine how long the reconstituted medication can be stored. Discard after that date. If medication can be reconstituted in different strengths, write the strength chosen.

Rule 13-5 (cont.) Reconstitute to the strength that will allow the desired dose in the smallest volume. Read the order carefully when calculating the amount to administer. Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2b Explain principles related to administration of liquid oral medications. If the medication can be reconstituted in different strengths, chose the one that will give the desired dose in the smallest volume. Dose is usually ordered in units of drug, not volume of liquid. Calculate the volume needed to administer the desired dose. Return to Pt Ed Slide 53

To calculate the volume of liquid oral medication to administer, use: proportion formula dimensional analysis Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2a. Calculate dosages for liquid oral medications.

Find the amount to administer. Ordered: Granisetron 5 mg PO now On hand: Granisetron 2 mg per 10 mL oral solution Use the calculation method of choice. Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2a. Calculate dosages for liquid oral medications.

Calculating Dosages – Liquid Oral Medications (cont.)
H = 2 mg ; Q = 10 mL; D = 5 mg Step A Convert No conversion is necessary. Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2a. Calculate dosages for liquid oral medications. Step A dose ordered is the same unit of measure as dose ordered, so no conversion is necessary.

Step B Proportion H/Q = D/A or H:Q = D:A 2 mg/10 mL = 5 mg/A 2 x A = 10 mL x 5 2A/2 = 50 mL/2 A = 25 mL Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2a. Calculate dosages for liquid oral medications.

Step B Dimensional analysis A = Q/H x D/1 A mL = 10 mL/2 mg x5 mg/1 A mL = 50 mL/2 A mL= 25 mL Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2a. Calculate dosages for liquid oral medications.

Step B Formula Method 5mg/2mg x 10 mL = A 50 mL/2 = A 25 mL = A Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2a. Calculate dosages for liquid oral medications.

Step C Think! Is It Reasonable? 5 mg is two and one-half times 2 mg, and 25 mL is 2.5 times 10 mL, so it is a reasonable amount. Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2a. Calculate dosages for liquid oral medications.

Patient Education Review steps for reconstitution of medications.
Follow Rule Read the label to learn how to store the medication. To Rule 13-5 Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2b Explain principles related to administration of liquid oral medications. Be sure the patient understands how to reconstitute the medication. Review Rule 13-5 on slides 43, 44, 45.

Patient Education Use the measuring device provided or a device specifically made for measuring medications. Household teaspoons and tablespoons do not always measure liquids accurately. Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2a. Calculate dosages for liquid oral medications.

Do not store medication longer than the label indicates. It may lose potency. Its chemical composition may change. Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2b Explain principles related to administration of liquid oral medications. Properly discard any left over medication.

Wash measuring device after each use. Use hot water and dish detergent. Dry thoroughly. Store in clean container. Keep liquid medication in original container. Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2b Explain principles related to administration of liquid oral medications. Never transfer a liquid medication to another container.

Practice What liquid is used to reconstitute this medication? How much liquid is added? What, if any, are the additional instructions? ANSWER: water ANSWER: 154 mL ANSWER: shake vigorously after adding water Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2b Explain principles related to administration of liquid oral medications. Refer to Figure in book.

Practice Ordered: Erythromycin oral suspension 0.5 g po q6 h On hand: see label (prior slide) What is the amount to administer? Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2a. Calculate dosages for liquid oral medications. H = 200 mg Q = 5 mL D = 0.5 g Step A x:0.5 g = 1000 mg : 1 g [cancel units (g)] 0.5 x 1000 mg = x X 1 500 mg = x Step B 500 mg / 200 mg x 5 mL = A [ cancel units (mg)] 2.5 x 5 mL = 12.5 mL = A Step C 500 mg is 2.5 times 200 mg so it is reasonable. ANSWER: mL

In Summary In this chapter you learned to
demonstrate administration of solid oral medications by a. calculating dosages; b. explaining related principles. Solid forms tablet caplets capsules gelcaps enteric-coated tablets spansules Dosage calculation – use one of three methods: Proportion Dimensional analysis Formula method Follow the three steps: Convert Calculate Think! Is It Reasonable?

Apply Your Knowledge True or False
___ Any tablet can be broken in half to give a patient the correct dose. ___ Enteric-coated tablets can be crushed and given through an NG tube. ___ Some spansules can be pulled apart so the granules can be given with applesauce. F Only scored tablets should be broken. F Medication could be broken down by stomach acid, or it could injure the stomach lining. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Remember! Granules should never be crushed. T

Apply Your Knowledge Which of the following foods are contraindicated to mix with tetracyclines? Water Orange juice Milk Applesauce Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Tetracycline is inactivated by milk and milk products, as well as antacids, vitamins, and minerals. Orange juice is acceptable unless it has added calcium.

Apply Your Knowledge Which of the following types of medications may be crushed for administration? Scored tablets Enteric-coated tablets Sustained-release tablets Spansules Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. The absorption rates for the other forms of medications may be altered if they are crushed.

Apply Your Knowledge What preparation must be done before administering a crushed medication through a nasogastric tube? Nothing special is needed. Mix the medication with applesauce. Mix the medication with warm water. Mix the medication with ice cream. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Warm water helps dissolve the medication to make it easier to instill through the NG tube.

Apply Your Knowledge What is an advantage of liquid oral medications? How do you find out what and how much you should use to reconstitute a medication in powder form? ANSWER: greater range of dosages can be ordered and administered Learning Outcome: 13.2 Demonstrate administration of liquid oral medications. Learning Outcome: 13.2b Explain principles related to administration of liquid oral medications. ANSWER: read the label or the package insert

Apply Your Knowledge True or False F F T
___ You must write only the date and time you reconstituted the medication on the label.. ___ The physician will only order doses of liquid oral medications in volume of liquid. ___ When reconstituting a medication, select a strength that will provided the desired dose in the smallest volume. F You also have to write your initials and strength, if needed. F Medications are usually ordered in units of drug, rather than volume. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. You must include the strength on the label if the medication can be reconstituted in more than one strength. T

End of Chapter 13 If you want to achieve excellence, you can get there today. As of this second, quit doing less-than-excellent work. -- Thomas John Watson, Jr.

Chapter 13 Oral Dosages PowerPoint® Presentation to accompany:

Similar presentations

Presentation on theme: "Chapter 13 Oral Dosages PowerPoint® Presentation to accompany:"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

Chapter 13 Oral Dosages PowerPoint® Presentation to accompany:

Similar presentations

Presentation on theme: "Chapter 13 Oral Dosages PowerPoint® Presentation to accompany:"— Presentation transcript:

Similar presentations

About project

Feedback