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

2. Copyright © 2015 Cengage Learning® par·en·ter·al (pă-rĕn′tər-əl)adj.1. Physiology Located outside the digestive tract. 2. Medicine Taken into the body or administered in a manner other than through the digestive tract, as by intravenous or intramuscular injection.

3. Copyright © 2015 Cengage Learning® Parenteral Routes IV (intravenous) –Most common IM (intramuscular) Subcutaneous –Second most common sub·cu·ta·ne·ous (sŭb′kyoo-tā′nē-əs)adj.Located or placed just beneath the skin: subcutaneous tissue; a subcutaneous implant. Intradermal in·tra·der·mal (ĭn′trə-dûr′məl)adj.Within or between the layers of the skin: an intradermal injection. 9-3

4. Copyright © 2015 Cengage Learning® Subcutaneous injections are administered in the fat layer, underneath the skin. Intramuscular injections are delivered into the muscle. Intradermal injections are delivered into the dermis, or the skin layer underneath the epidermis (which is the upper skin layer). 4

5. Copyright © 2015 Cengage Learning® 5

6. Packaging Parenteral medications are available in ampules, vials, prefilled syringes, bag solutions, and bottled solutions. 9-6

7. 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. 9-7

8. 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. 9-8

9. 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. 9-9

10. Copyright © 2015 Cengage Learning® IV Medication Preparation Administration usually two-step procedure: 1.Prepare dosage 2.Dilute in IV fluids 9-10

11. Copyright © 2015 Cengage Learning® Solution Labels Metric/SI (examples) –morphine sulfate 4 mg/mL –digoxin 75 mcg/mL –cefazolin 1 gram/50 mL See Examples 1 & 2, p. 103 Percent (examples) –1% lidocaine –10% calcium gluconate –0.45% sodium chloride (continues) 9-11

12. 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) 9-12

13. Copyright © 2015 Cengage Learning® Solution Labels (cont’d) mEq (examples) –20 mEq potassium chloride (KCl) –50 mEq sodium bicarbonate (NaHCO 3 ) 9-13

14. Copyright © 2015 Cengage Learning® Safety Point Labels of most parenteral solutions are quite small. –Read with particular care. 9-14

15. 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) 9-15

16. Copyright © 2015 Cengage Learning® Example 1 (cont’d) Convert 1/150 grains to 0.4 mg 1 gr = 60 mg (apothecary measure) Convert 1/150 gr to mg first. Then calculate mL needed. Use basic formula: 9-16

17. 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) 9-17

18. Copyright © 2015 Cengage Learning® Example 2 (cont’d) Use basic formula: 9-18

19. 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) 9-19

20. Copyright © 2015 Cengage Learning® Example 3 (cont’d) Use basic formula: 9-20

21. Copyright © 2015 Cengage Learning® Example 4 Prescription for promethazine sulfate 25 mg IV bolus Promethazine sulfate vial labeled 25 mg/mL (continues) 9-21

22. Copyright © 2015 Cengage Learning® 22 bo·lus ˈ bōləs/ noun noun: bolus; plural noun: boluses 1.a small rounded mass of a substance, especially of chewed food at the moment of swallowing. 2.a type of large pill used in veterinary medicine. 3.Medicine 4.a single dose of a drug or other medicinal preparation given all at once.

23. 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) 9-23

24. 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 9-24

25. 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) 9-25

26. Copyright © 2015 Cengage Learning® Example 5 (cont’d) How many mL should be administered per intravenous bolus? (continues) 9-26

27. Copyright © 2015 Cengage Learning® Use basic formula: Example 5 (cont’d) 9-27

28. Copyright © 2015 Cengage Learning® Work through each of the problem sets in Chapter 9 in your text. Put your work in your notebook. Take the Summary Self Test in your notes. Take the Chapter 9 OnLine Quiz and report your results. 28