nursing pharmacology 2011
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15 minutes break only. You may bring finger-foods.
Pharmacology
Darran Earl Gowing, RN, MN
Have you wondered?
Why it’s usually okay to give children Tylenol but not aspirin? Why a lot of middle-aged and older people take an aspirin a day? Why people with high blood pressure, heart failure, or diabetes take ACE inhibitors and what ACE inhibitors are? When an antibiotic should NOT be prescribed for an infection?
Why Study Pharmacology?
A. To pass the requirement.B. You will be able to use fancy terms
like “Pharmacodynamics”.C. My instructor likes to torture people.D. A competent nurse must understand
why his/her patient is getting a medication, and HOW IT WORKS.
PurposeThe purpose of studying PHARMACOLOGY is to help you learn about medicines and the WHY, WHAT, HOW, WHEN, and WHERE they are used in daily life.
Origin of Drugs
BEFORE…Drugs were mainly derived from
Plants (eg, morphine)animals (eg, insulin)and minerals (eg, iron)
ORIGIN2700 BB – earliest
recorded drug use found in Middle East & China
1550 BC – Egyptians created Ebers Medical Papyrus
ORIGINGalen (131-201 AD) Roman
physician; initiated common use of prescriptions
1240 AD – introduction of apothecary system (Arab doctors)
1st set of drug standards & measurements (grains, drams, minims), currently being phased out
ORIGIN15th century –
apothecary shops owned by barber, surgeons, physicians, independent merchants
18th century – small pox vaccine (by Jenner)Digitalis from foxglove plant for strengthening & slowing of heartbeat Vitamin C from fruits
ORIGIN19th century – morphine &
codeine extract from opiumIntroduction of atropine & iodineAmyl nitrite used to relieve anginal painDiscovery of anesthetics (ether, nitrous oxide)
Early 20th century – aspirin from salicylic acidIntroduction of Phenobarbital, insulin, sulforamides
ORIGINMid 20th century1940 – Discovery
antibiotics (penicilline, tetracycline,
streptomycin), antihistamines, cortisone
1950 – discovery antipsychotic drug, antihypertensives, oral contraceptives, polio vaccine
Dr Albert Sabin, b. 1906, developer of the oral live polio vaccine.
NOW…SyntheticSemi-syntheticBiotechnology
Knowing the terms!
Pharmacology pharmacon - meaning druglogos - meaning scienceis the study of drugs (chemicals) that alter functions of living organisms.
Drug therapyalso called pharmacotherapy, is the use of drugs to prevent, diagnose, or treat signs, symptoms, and disease processes.
Medication Drugs given for therapeutic purposes.
Pharmacoeconomics involves the costs of drug therapy, including those of purchasing, dispensing, storage, administration, laboratory and other tests used to monitor client responses, and losses from expiration.
DrugAny chemical that affects the physiologic processes of a living organism
DrugsChemical name• Describes the drug’s chemical
composition and molecular structureGeneric name (non-proprietary
name)• Name given by the country or
Adopted Name Council
Trade name (proprietary name)• The drug has a registered trademark;
use of the name restricted by the drug’s patent owner (usually the manufacturer)
DrugsChemical name• (+/-)-2-(p-
isobutylphenyl) propionic acid
Generic name• Ibuprofen
Trade name• Alaxan®, Advil®
Classification• Classification:–Functional Class vs. Chemical Class
• Medication classification indicates:– effect of the medicine– symptom the medicine relieves– medicine desired effect (e.g. oral hypoglycemics)
Classification
A medication may also be part of more than one class Aspirin is an analgesic, antipyretic, anti-inflammatory, and anti-platelet
Medication FormsMedications are available in a variety of forms and preparationsThe form of the med will determine its route of administrationComposition of med is designed to enhance its absorption & metabolism
Medication FormsTabletCapsuleCapletElixirEnteric-coatedSuppositorySuspension
Transdermal patchDropsInjectionsOintmentTinctureLinimentAerosol
Tablets
Capsule
Caplet
ENTERIC COATED
Suspension
Subcutaneous Injection
Intramuscular or IM
Ointment
Elixir
Patch
Eye Drops or Eye Ointment
Ear Drops
Aerosol
Suppositories
Pharmacologic Principles
PhasesPharmaceuticsPharmacokineticsPharmacodynamicsPharmacotherapeuticsPharmacognosy
Drug available for action
Dose of Formulated Drug
Disintegration of dosage from dissolution of drug
Absorption, distribution,metabolism, excretion
Administration
Drug-receptorinteraction
Drug available for absorption
EFFECT
PHARMACEUTICAL PHASE
PHARMACOKINETIC PHASE
PHARMACODYNAMIC PHASE
PHASES OF DRUG ACTIVITY(source: Mosby’s Pharmacology for Nursing (2003))
PharmaceuticsThe study of how various drug forms influence pharmacokinetic and pharmacodynamic activities
Figure 2-1 The chemical, generic, and trade names for the common analgesic ibuprofen are listed next to the chemical structure of the drug.
Drug Transport
What does this have to do with drug administration?Drugs must reach and interact with or cross the cell membrane to stimulate or inhibit cellular function
PharmacokineticsThe study of what the body does to the drug–Absorption–Distribution–Metabolism–Excretion
Remember: ”ADME”
Pharmacokinetics
Pharmacokinetics: Absorption
The rate at which a drug leaves its site of administration, and the extent to which absorption occurs–Bioavailability–Bioequivalent
Factors That Affect Absorption
• Administration route of the drug• Ability of Medicine to Dissolve• Food or fluids administered with the drug• Body Surface Area• Status of the absorptive surface• Rate of blood flow to the small intestine• Lipid Solubility of Medicine• Status of GI motility
Factors Affecting Pharmacokinetics
AgeDiseasesIndividual DifferencesPsychological FactorsType & Amount of Drug PrescribedSocial Factors
Routes
Oral
Pills, capsules, tablets, liquidsSL, Buccal, NG, Gastrostomy, Duodenostomy tubes
NOTE:Assess client’s ability to take oral medications
Oral Drugs
Dosage is determined by how much of the drug is required to be taken by mouth to given the desired affect.Time in the stomach – is the stomach empty – full – does it make a difference on how drug is absorbedSmall intestine – large surface area for absorption of nutrients and minerals
What else might influence oral drug absorption?
Food in stomachCertain juices – grapefruit juice Milk – binds with molecules of some drugs so that the drug is never absorbedOrange juice – enhances absorption of iron taken orallyThe coating on the tablet: chewable, enteric coated (breakdown occurs in small intestine), slow release capsules
Intradermal Sites
Ventral forearmUpper chestShoulder
Subcutaneous Sites
Outer aspects of the arms & thighsHip & lower abdomenAbove the iliac crest
Intramuscular
Ventrogluteal for 1 year and above
Intramuscular
Vastus lateralis
below 1 year old
Intramuscular
Dorsogluteal - clients w/ well-developed gluteal muscles
Intramuscular
Deltoid
Intravenous
(IV) is the installation of fluid and/or electrolytes, or nutrient, medication substances into a vein.
Topical Agent
skin, ophthalmic, otic, nasal, vaginal, rectal
Inhalation
Distribution
Transportation of drug molecules within the bodyDrug needs to be carried to the site of the action
Need blood to circulate the drugHeart, liver, kidneys
Key Concepts of Distribution
Protein binding – drug molecules need to get from the blood plasma into the cellProtein binding allows part of the drug to be stored and released as neededSome of the drug is stored in muscle, fat and other body tissues and is gradually released into the plasma
Just how does the drug get into the cell?
Drug must pass though the capillary wallBlood brain barrier – very effective in keeping drugs from getting into the central nervous system or CNS – limits movement of drug molecules into brain tissue
Blood Brain Barrier
This is especially important when treating infections of the brain such as meningitis, encephalitis, or brain abscessMedications must be able to penetrate the blood brain barrierMedications usually given intravenous
Three ways to get in!• Direct penetration of the membrane• Protein channels• Carrier proteins
# 1 Lipid Soluble Drugs• Lipid soluble drugs are able to dissolve in
the lipid layer of the cell membrane• No energy expended by the cell• Passive diffusion– Oral tablets or capsules must be water
soluble to dissolve in fluids of the stomach and small intestine
# 2 Protein Channels
Most drug molecules are to big to pass in to the cell via the channels – small ions such as sodium and potassium use the protein channels but their movement is regulated by gating mechanisms – only small amounts allowed
# 3 Carrier Proteins
Molecule needs to bind with a protein that will transport it from one side of the cell membrane to another – a drugs structure determines which carrier will transfer it.
Metabolism• Method by which the drugs are inactivated
or biotransformed by the body– Active drugs contain metabolites that
are excreted – skin, urine, stool• Most drugs metabolized in the liver by
cytochrome P450 (CYP)
What can stop this process?
• Enzyme inhibition– Other drugs– Combination drugs– Liver disease – Impaired blood circulation in person with
heart disease– Infant with immature livers–Malnourished people or those on low-
protein diets
An important concept!• First-pass effect – some drugs are
extensively metabolized or broken down in the liver and only a part of the drug is released into the systemic circulation
• This is why dosage is important – how much drug needs to be taken in to give the desired effect and how often does it need to be taken
Excretion
Refers to the elimination of the drug from the bodyRequires adequate functioning of the circulatory system and organs of excretion
KidneysBowelsLungsSkin
You are caring for a client who has diabetes complicated by kidney disease. You will need to make a detailed assessment when administering medications because this client may experience problems with:
A. AbsorptionB. BiotransformationC. DistributionD. Excretion
Laboratory Values• Laboratory values reflecting function of
liver and kidneys need to be looked at. – BUN and Creatinine – kidney function– Liver function tests:• ALT – alamine aminotransferase
(elevated in hepatitis)• AST or SGOT– aspartate
aminotransferase – elevated in liver disease • Bilirubin levels – infants – gallstones in
adults
Serum Drug Levels• Laboratory measurement of the amount of
drug in the blood at a particular time• A minimum effective concentration (MEC)
must be present before a drug exerts its action on a cell.
Toxic Levels• Excessive level of a drug in the body– Single large dose– Repeated small doses– Slow metabolism which allows drug to
accumulate in the body– Slow excretion from the body by the
kidneys or gastrointestinal tract
Laboratory values are important!
• Serum drug levels indicate the onset, peak and duration of the drug action
Do we do serum drug levels for all drugs?
• No • When do we need them?– Drugs with narrow margin of safety
(digoxin, aminoglycoside antibiotics, lithium)
– To check to see if the drug is at therapeutic levels – seizure medications
–When drug overdose is suspected
Important concept!• Serum half-life or elimination half-life is the
time it takes the serum concentration of the drug to reach 50%– A drug with a short half-life requires
more frequent administration– A drug with a long half-life requires less
frequent administration
Why is this important?• Half-life determines how often a drug is
given– Daily in the morning– At bedtime– Q.I.D - four times a day– T.I.D – three times a day– Q4 hours – every four hours– Q 12 hours – 9 am and 9 pm
Pharmacodynamics• The study of
what the drug does to the body the mechanism of drug actions in living tissues
“WHAT THE DRUG DOES TO THE BODY”
Cellular Physiology
What does a cell do?Exchange materialObtain energy from nutrientsSynthesize hormones, neurotransmitters, enzymes, structural proteins and other complex moleculesDuplicate themselves
Pharmacodynamics
Drugs can:1.Inhibit2.Activate3.Replace
Enzyme Interaction• Enzymes are substances that catalyze
nearly every biochemical reaction in a cell• Drugs can interact with enzyme systems
to alter a response• Inhibits action of enzymes-enzyme is
“fooled” into binding to drug instead of target cell
• Protects target cell from enzyme’s action (ACE Inhibitors)
Receptor theory
Most drugs exert their effects by chemically biding with receptors at the cellular level.Receptors are proteins located
on the surfaces of cell membranes within the cells
What do the RECEPTORS do?
The receptors are often described as the lock into which the drug molecule fits as a key.All body cells do not respond to all drugs even when all the cells are exposed to the drug.
RECEPTOR
LOCKS KEYS
PharmacodynamicsReceptors are
regulated in TWO WAYS:
1.Agonists (activators) – bind to the receptor and act to produce a pharmacologic effect
2.Antagonists (blockers) – bind to the receptor and prevent the cell from producing an effect
Agonist-Antagonist
More is not better!
Number of receptors site available will effect drug action so giving a higher dose does not necessarily produce additional pharmacological effects.
Drug Dosing
Often the first dose is higher in an effort to bring the therapeutic blood serum levels up quicker
Drug – Diet interaction
Food can slow absorptionFood substances can react with certain drugsHow to give medication is information provided in you drug manual
Drug – Drug Interaction• Some drugs taken together will enhance
each other – Tylenol with codeine
• Some drugs taken together will interfere with another drugs actions
• Some drugs are given to decrease or reverse the toxic effects of a drug– Narcotic antidote is naloxone
Drug Tolerance
Body becomes accustomed to drug over period of time
Adverse Effects• Undesired response• Allergic reaction• Drowsiness• Nausea / vomiting / GI upset• Liver or kidney damage• Fevers• Drug dependency• Cancinogenicity – ability to cause cancer• Teratogenicity – cause damage to fetus
Pharmacotherapeutics
The use of drugs and the clinical indications for drugs to prevent and treat diseases
MonitoringThe effectiveness of the drug therapy must be evaluated.One must be familiar with the drug’s intended therapeutic action (beneficial) and the drug’s unintended but potential side effects (predictable, adverse drug reactions).
Types of Therapies
Acute therapyMaintenance therapySupplemental therapyPalliative therapySupportive therapyProphylactic therapy
Type of Medication Action
Therapeutic EffectSide EffectsAdverse EffectsToxic EffectIdiosyncratic ReactionsAllergic ReactionMedication InteractionsIatrogenic Response
Therapeutic Effect
The expected or predictable physiological response a medication causesA single med can have several therapeutic effects
Side Effects
‘A drug that does not
cause side-effects is a drug that does not work.’
Unintended secondary effects a medication predictably will causeMay be harmless or seriousIf side effects are serious enough to negate the beneficial effect of meds therapeutic action, it may be D/CPeople may stop taking medications because of the side effects
ADVERSE RECTION
• Medication misadventures–Adverse drug events–Adverse drug reactions –Medication errors
Adverse Effects
Undesirable response of a medicationUnexpected effects of drug not related to therapeutic effectMust be reported to FDACan be a side effect or a harmful effectCan be categorized as pharmacologic, idiosyncratic, hypersensitivity, or drug interaction
Toxic effect
ToxicologyThe study of poisons and unwanted responses to therapeutic agents
Toxic Effect
May develop after prolonged intake or when a medicine accumulates in the blood because of impaired metabolism or excretion, or excessive amount takenToxic levels of opioids can cause respiratory depressionAntidotes available to reverse effects
Table 2-9 Common Poisons and Antidotes
Idiosyncratic Reactions
Unpredictable effects-overreacts or under reacts to a medication or has a reaction different from normalNormal effect is produce by a small fraction of the standard dose.
Allergic Reaction
Unpredictable response to a medicationMakes up greater than 10% of all medication reactionsClient may become sensitized immunologically to the initial dose, repeated administration causes an allergic response to the medicine, chemical preservative or a metabolite
Allergic Reaction
Medication acts as an antigen triggering the release of the body’s antibodiesMay be mild or severe
A postoperative client is receiving morphine sulfate via a PCA. The nurse assesses that the client’s respirations are depressed. The effects of the morphine sulfate can be classified as:
A. AllergicB. IdiosyncraticC. TherapeuticD. Toxic 35 - 114
Other Drug Reactions
Teratogenic-Structural effect in unborn fetusCarcinogenic-Causes cancerMutagenic- Changes genetic composition (radiation, chemicals)
Iatrogenic ResponsesUnintentional adverse effects that occur during therapyTreatment Induced Dermatologic
rash, hives, acneRenal Damage
Aminoglycoside antibiotics, NSAIDS, contrast medium
Blood DyscrasiasDestruction of blood cells (Chemotherapy)
Hepatic ToxicityElevated liver enzymes
DRUG INTERACTIONS
InteractionsAdditive effectSynergistic effectAntagonistic effectIncompatibility
ADDITIVE EFFECT
Drugs are said to have an additive effect when they have similar actions. Lower doses are needed when the drugs are given together.Similar therapeutic activity can cause problems if administered together
Synergistic Effect
Effect of 2 meds combined is greater than the meds given separatelyAlcohol & Antihistamines, antidepressants, barbiturates, narcotics
ANTAGONIST EFFECT
Combined effect is less than each of them alone.Drugs with opposite action to that of another drug or natural body chemicalExamples: Beta-blockers the ‘olol’ drugs
INCOMPATIBILITY EFFECT
Drugs are incompatible when combining them causes chemical deterioration of one or both
NURSING RESPONSIBILITY
The Nursing Process
Assessment
Diagnosis
PlanningImplementation
Evaluation
Assessment
Diagnosis
PlanningImplementation
Evaluation
The Nursing Process
Assessment• Data collection – Subjective, objective– Data collected on the patient, drug,
environment
• Medication history• Nursing assessment• Physical assessment• Data analysis
Constant System Analysis
• A “double-check”• The entire “system”
of medication administration
• Ordering, dispensing, preparing, administering, documenting
• Involves the physician, nurse, nursing unit, pharmacy department, and patient education
Administering Medications
1. Right Patient 2. Right Medication 3. Right Dosage 4. Right Route 5. Right Time 6. Right Documentation7. Right Client Education 8. Right to Refuse 9. Right Assessment 10. Right Evaluation
Other “Rights”
Proper drug storageCareful checking of transcription of ordersPatient safetyClose consideration of special situationsPrevention and reporting of medication errorsMonitoring for therapeutic effects, side effects, toxic effects
Evaluation
Ongoing part of the nursing processDetermining the status of the goals and outcomes of careMonitoring the patient’s response to drug therapy
Assessment
Diagnosis
PlanningImplementation
Evaluation
Questions???The day shift charge nurse is making rounds. A patient tells the nurse that the night shift nurse never gave him his medication, which was due at 11 PM. What should the nurse do first to determine whether the medication was given?
1.Call the night nurse at home.2.Check the Medication sheet.3.Call the pharmacy.4.Review the nurse’s notes.
Questions???The patient’s Medication sheet lists two antiepileptic medications that are due at 0900, but the patient is NPO for a barium study. The nurse’s coworker suggests giving the medications via IV because the patient is NPO. What should the nurse do?
1.Give the medications PO with a small sip of water.
2.Give the medications via the IV route because the patient is NPO.
3.Hold the medications until after the test is completed.
4.Call the physician to clarify the instructions.
Know your drug• Clients expect you to be knowledgeable• You gain this knowledge be looking up
medications– Drug hand book– PDA– Pharmacist
Legal Responsibilities• The nurse is responsible for–safe and accurate administration–having sufficient drug knowledge
to recognize and question erroneous orders–actions delegated to other persons
– orderly cannot give medications–monitor clients response to a
medication– following safe practices – the ten
rights
Medication Systems
Each facility has a system for administering medicationBe familiar with this process & need to learn at each new facilityBasics of medication administration guidelines should always be observed
Medication Orders• Full name of client• Generic or trade name of drug• Dose, route, frequency • Date, time and signature of provider• The nurse will need to look up the
medication ordered to know it’s classification, safe dose, action, how to administer, and side effects
• The nurse should know why the medication is ordered
LIFE SPAN CONSIDERATIONS
Life Span Considerations
• Pregnancy• Breast-feeding• Neonatal• Pediatric• Geriatric
Pregnancy
First trimester is the period of greatest danger for drug-induced developmental defectsDrugs diffuse across the placentaFDA pregnancy safety categories
PREGNANCY CLASSIFICATION
Class AStudies failed to demonstrate fetal anomalies.
Class BAnimal studies have not demonstrated a fetal risk.Information in human is not available
PREGNANCY CLASSIFICATION
Class CStudies in animal have revealed an adverse effect
Class DThere is a positive evidence of fetal risk but in some cases may warrant the use of these drugs
Class XStudies in animal and human have revealed abnormalities
Breast-feeding
• Breast-fed infants are at risk for exposure to drugs consumed by the mother
• Consider risk-to-benefit ratio
Table 3-2 Classification of young patients
Pediatric Considerations: Pharmacokinetics
• Absorption– Gastric pH less acidic– Gastric emptying is
slowed– Topical absorption
faster through the skin
– Intramuscular absorption faster and irregular
Pediatric Considerations
• Distribution– TBW 70% to 80% in
full-term infants, 85% in premature newborns, 64% in children 1 to 12 years of age
– Greater TBW means fat content is lower
– Decreased level of protein binding
– Immature blood-brain barrier
Pediatric Considerations
• Metabolism–Liver immature,
does not produce enough microsomal enzymes–Older children
may have increased metabolism, requiring higher doses–Other factors
Pediatric Consideration
• Excretion– Kidney immaturity
affects glomerular filtration rate and tubular secretion
– Decreased perfusion rate of the kidneys
Summary of Pediatric Considerations
Skin is thin and permeableStomach lacks acid to kill bacteriaLungs lack mucus barriersBody temperatures poorly regulated and dehydration occurs easilyLiver and kidneys are immature, impairing drug metabolism and excretion
Methods of Dosage Calculation for Pediatric Patients
• Body weight dosage calculations
• Body surface area method
Geriatric Considerations
Geriatric: older than age 65Healthy People 2010: older than age 55
Use of OTC medicationsPolypharmacy
Geriatric Considerations: Pharmacokinetics
• Absorption– Gastric pH less acidic– Slowed gastric
emptying–Movement through
GI tract slower– Reduced blood flow
to the GI tract– Reduced absorptive
surface area due to flattened intestinal villi
Geriatric Considerations
• Distribution– TBW percentages
lower– Fat content increased– Decreased
production of proteins by the liver, resulting in decreased protein binding of drugs
Geriatric Considerations
• Metabolism–Aging liver
produces less microsomal enzymes, affecting drug metabolism–Reduced blood
flow to the liver
Geriatric Considerations
• Excretion–Decreased
glomerular filtration rate–Decreased
number of intact nephrons
Geriatric Considerations
• Analgesics• Anticoagulants• Anticholinergics• Antihypertensives• Digoxin• Sedatives and
hypnotics• Thiazide diuretics
MEDICATION ERRORS:PREVENTING & RESPONDING
Medication Misadventures
• By definition, all ADRs are also ADEs
• But all ADEs are not ADRs
• Two types of ADRs– Allergic reactions– Idiosyncratic reactions
Medication Errors
• Preventable• Common cause of
adverse health care outcomes
• Effects can range from no significant effect to directly causing disability or death
Common classes of medications involved in serious errors
Preventing Medication Errors
Minimize verbal or telephone orders
Repeat order to prescriberSpell drug name aloudSpeak slowly and clearly
List indication next to each orderAvoid medical shorthand, including abbreviations and acronyms
Preventing Medication
Never assume anything about items not specified in a drug order (i.e., route)Do not hesitate to question a medication order for any reason when in doubtDo not try to decipher illegibly written orders; contact prescriber for clarification
Preventing Medication
NEVER use “trailing zeros” with medication ordersDo not use 1.0 mg; use 1 mg1.0 mg could be misread as 10 mg, resulting in a tenfold dose increase
ALWAYS use a “leading zero” for decimal dosagesDo not use .25 mg; use 0.25 mg.25 mg may be misread as 25 mg “.25” is sometimes called a “naked decimal”
Preventing Medication
• Check medication order and what is available while using the “10 rights”
• Take time to learn special administration techniques of certain dosage forms
Preventing Medication Errors (cont'd)
Always listen to and honor any concerns expressed by patients regarding medications
Check patient allergies and identification
Nurses are legally required to document medications that are administered to clients. The nurse is mandated to document:
A. Medication before administering it
B. Medication after administering it
C. Rationale for administering the medication
D. Prescriber’s rationale for prescribing the medication
35 - 166
If a nurse experiences a problem reading a physician’s medication order, the most appropriate action will be to:
A. Call the physician to verify the order.
B. Call the pharmacist to verify the order.
C. Consult with other nursing staff to verify the order.
D. Withhold the medication until the physician makes rounds.
35 - 167
METRIC SYSTEM
Metric System
• Meter is used for linear measure, gram for weight and liter for volume
Apothecary System
Grains, minims, drams, ounces, pounds, pints, and quarts
Household measures
Drops, teaspoons, tablespoons and cupsImportant since this is often how people take medications
Units
mEq – drugs ordered in number of units per dose
Insulinheparin
Milliliters
mL = milliliter. This is a VOLUME measurement. it is 1/1000 of a liter. when talking about water or similar liquids, it is equivalent to one cubic centimeter.
Cubic Centimeter
cc = cubic centimeter. This is also a VOLUME measurement. Most syringes measure their capacity in cc's. If you have a 5cc syringe, it will hold ~5mL of liquid in it.
mL and cc’s• 1 mL = 1cc • 1 cc = 15 to 16 minims• 1 cc = 15 to 16 drops
• Fluids are generally written in cc’s to standardize the abbreviation – you may see mL’s written but this abbreviation is being eliminated
cc’s and household measures
• 5 cc = 1 tsp (teaspoon)• 15 cc = 1 tbs (tablespoon)• 30 cc = 1 oz (ounce) = 2
tablespoons• 240 cc = 8 oz or 1 cup
Milligrams• mg = milligram. This is a WEIGHT
measurement. It is 1/1000 of a gram. the amount of chemical substance is often measured in milligrams. For injectable solutions, this will be reported as a concentration of weight to volume, such as mg/ml (milligrams per milliliter).
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