1. Week 2 Medication Orders and Measurement Systems Chapters 5 and 7 Presented by: Dr. S 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 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 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 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. How are drugs named? Chemical name – based on structure Chemical name – based on structure –N-acetyl-p-aminophenol Generic/nonproprietary name – USP/NF official name Generic/nonproprietary name – USP/NF official name –acetaminophen (note it is lowercase) Trade/brand/proprietary name – manuf registered name while under patent Trade/brand/proprietary name – manuf registered name while under patent –Tylenol (note it is uppercase like a proper name) 15

16. 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 16

17. NDC 00006-0543-61 00006 is the code for manufacturer. In this case Merck & Co, Inc 00006 is the code for manufacturer. 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. 17

18. 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. 18

19. 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. 19

20. Week 2 Seminar Measurement Systems and Their Equivalents 20

21. Assignment Hints Show your work, so I can give partial credit Show your work, so I can give partial credit Utilize resources – seek help early Utilize resources – seek help early Don’t forget about the Math Center if you need help Don’t forget about the Math Center if you need help Save files with your name first, then assignment Msmith_caclulations_Unit3 Save files with your name first, then assignment Msmith_caclulations_Unit3 21

22. 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 22

23. 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) 23

24. 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 24

25. 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 25

26. 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

27. 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)

28. Which is correct? 2.0 g 2.0 g 0.2g 0.2g ¼ g ¼ g What are the “zero” rules? What are the “zero” rules? 28

29. Length Measurement Conversion Factors 1 Meter = 39.37 inches 2.5 cm = 1 inch 1 m = 1000 mm 1 m = 100 cm 1 cm = 10 mm 29

30. Meter Conversion Factors = 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 30

31. Let’s learn to convert units! Really just a 4 step process…. Really just a 4 step process…. 1. What units are we converting to and from? 1. What units are we converting to and from? 2. What is our conversion factor? 2. What is our conversion factor? 3. Set up equation so units cancel. Start with what you are given. 3. Set up equation so units cancel. Start with what you are given. 4. Carry out the math. 4. Carry out the math. 5. Review – does our answer make sense? 5. Review – does our answer make sense? 31

32. Length Conversion Factors How many cm is 75 mm? How many cm is 75 mm? 1.First determine the units you are converting to and from – mm to cm 2. Our conversion factor is 1 cm = 10 mm 3. Then use your conversion factor setting up so units cancel. Start with what you are given. 75mm x 1cm/10mm = 4. Carry out the math 75 x 1/10 = 7.5 cm 75 x 1/10 = 7.5 cm 5. Does our answer make sense? Should we have a smaller number for cm? 75 mm = 7.5 cm (remember 1 cm = 10 mm) 32

33. Let’s go through it again… 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 33

34. Let’s try another length example How many mm in 2.5 m? _____mm = 2.5 m 1. We are given m and want mm as our answer 2. What is our conversion factor (page 133)? 1 m = 1000 mm 3. Set up equation so units cancel 2.5m x 1000mm/1m = 4. Carry out math 2.5 x1000/1 = 2500 mm 5. Review – does our answer make sense? look at conversion factor 1m = 1000 mm 34

35. What would happen if we set it up like this? 2.5 m x 1m/1000mm = Can you tell why it is wrong? Should our final answer be larger or smaller than our original number? conversion factor is 1 m = 1000 mm 35

36. Try this on your own How many mm in 3.6 m? How many mm in 3.6 m? 1. I am converting from ………. 2. My conversion factor is……. 3. My equation set – up is…… 4. My answer is…… 5. My answer makes sense! 36

37. How did you do? How many mm in 3.6 m? 1. I have m and want to convert to mm. 2. My conversion factor is found on page 133 and is 1 m = 1000 mm 3. My set up is: 3.6 m x 1000 mm/1 m (m cancel out!) 4. When I solve it I get 3600 mm 5. Based on the conversion factor and the fact that mm are smaller than m, my answer makes sense! 3600 mm = 3.6 m 37

38. Metric Volume Conversion Factors based on Liter Metric Volume Conversion Factors based on Liter =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 38

39. Volume Conversion Factors 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) 39

40. Metric Weight Conversion Factors based on 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 40

41. 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) Mark pages in text where common conversions are found – better yet – make your own list! (you’ll thank yourself!) 41

42. Weight Measurement Conversion Factors 1 kg = 2.2 pounds 1 kg = 1000 g 1 mg = 0.001g 1 mg = 1000 mcg or µg 42

43. Let’s practice with weight conversions How many mg in 8 g? 1.I want to go from g to mg. 2.My conversion factor is 1000 mg = 1 g 3.My set up is 8 g x 1000mg/g = 4.When I solve it I get 8000 mg 5.My answer makes sense because I am going from a larger unit to a smaller 43

44. Your turn How many mg in 635 mcg? How many mg in 635 mcg? 1. What units are we going to and from? 1. What units are we going to and from? 2. What is my conversion factor? 2. What is my conversion factor? 1 mg = 1000mcg or µg 3. Set up equation. Start with what you are given. 3. Set up equation. Start with what you are given. 4. Solve. 4. Solve. 5. Does it make sense? 5. Does it make sense? 44

45. How did you do? How many mg in 635 mcg? How many mg in 635 mcg? 1. I have mcg and want to convert to mg. 1. I have mcg and want to convert to mg. 2. 1 mg = 1000 mcg 2. 1 mg = 1000 mcg 3. 635 mcg x 1 mg/1000 mcg 3. 635 mcg x 1 mg/1000 mcg 4. 0.635 mg 4. 0.635 mg 5. Mcg are smaller than g so my answer makes sense! 5. Mcg are smaller than g so my answer makes sense! 45

46. Apothecary System Conversion Factors 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 46

47. Household System Conversion Factors 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 47

48. You are doing great! Keep practicing! Resources include: Quiz Review Workbook (answers in doc sharing) Math Resource Center Me! 48