1. Copyright © 2015 Cengage Learning® Chapter 9 Parenteral Medication Labels and Dosage Calculation

2. Copyright © 2015 Cengage Learning® Parenteral Routes IV (intravenous) –Most common IM (intramuscular) Subcutaneous –Second most common Intradermal 9-2

3. Copyright © 2015 Cengage Learning® Packaging Parenteral medications are available in ampules, vials, prefilled syringes, bag solutions, and bottled solutions. 9-3

4. Copyright © 2015 Cengage Learning® Labels of Parental Solutions The labels of oral parental solutions are very similar, but the size of the average parental dosage label is much smaller. 9-4

5. Copyright © 2015 Cengage Learning® IM Solutions Manufactured so average adult dosage is contained in a volume between 0.5 mL and 3 mL. Most dosages prepared using 3 mL syringe. 9-5

6. Copyright © 2015 Cengage Learning® Subcutaneous Solutions Manufactured so average adult dosage is contained in a volume between 0.5 mL and 1 mL. Most dosages prepared using 3 mL or TB syringe. 9-6

7. Copyright © 2015 Cengage Learning® IV Medication Preparation Administration usually two-step procedure: 1.Prepare dosage 2.Dilute in IV fluids 9-7

8. Copyright © 2015 Cengage Learning® Solution Labels Metric/SI (examples) –morphine sulfate 4 mg/mL –digoxin 75 mcg/mL –cefazolin 1 gram/50 mL Percent (examples) –1% lidocaine –10% calcium gluconate –0.45% sodium chloride (continues) 9-8

9. Copyright © 2015 Cengage Learning® Solution Labels (cont’d) Ratio (examples) –5000 : 1 heparin –2500 : 1 heparin –1000 : 1 epinephrine International unit (examples) –heparin: 5000 international units –Factor VIII: 4550 international units –Factor IX: 2300 international units (continues) 9-9

10. Copyright © 2015 Cengage Learning® Solution Labels (cont’d) mEq (examples) –20 mEq potassium chloride (KCl) –50 mEq sodium bicarbonate (NaHCO 3 ) 9-10

11. Copyright © 2015 Cengage Learning® Safety Point Labels of most parenteral solutions are quite small. –Read with particular care. 9-11

12. Copyright © 2015 Cengage Learning® Example 1 Prescription for atropine 1/150 grains subcutaneously Atropine vial labeled 0.4 mg/mL How many mL should be administered subcutaneously? (continues) 9-12

13. Copyright © 2015 Cengage Learning® Example 1 (cont’d) Convert 1/150 grains to 0.4 mg Use basic formula: 9-13

14. Copyright © 2015 Cengage Learning® Example 2 Prescription for heparin 5000 units subcutaneously Heparin vial labeled 10,000 : 1 mL heparin How many mL should be administered subcutaneously? (continues) 9-14

15. Copyright © 2015 Cengage Learning® Example 2 (cont’d) Use basic formula: 9-15

16. Copyright © 2015 Cengage Learning® Example 3 Prescription for morphine sulfate 2 mg IV Morphine sulfate prefilled syringe contains 4 mg/mL How many mL should be administered intravenously? (continues) 9-16

17. Copyright © 2015 Cengage Learning® Example 3 (cont’d) Use basic formula: 9-17

18. Copyright © 2015 Cengage Learning® Example 4 Prescription for promethazine sulfate 25 mg IV bolus Promethazine sulfate vial labeled 25 mg/mL (continues) 9-18

19. Copyright © 2015 Cengage Learning® Example 4 (cont’d) 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? (continues) 9-19

20. Copyright © 2015 Cengage Learning® Example 4 (cont’d) 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 9-20

21. Copyright © 2015 Cengage Learning® 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 (continues) 9-21

22. Copyright © 2015 Cengage Learning® Example 5 (cont’d) How many mL should be administered per intravenous bolus? (continues) 9-22

23. Copyright © 2015 Cengage Learning® Use basic formula: Example 5 (cont’d) 9-23