Week 2Week 2 Medication Medication

Orders/Rx’s Orders/Rx’s chapter 5chapter 5

Measurement Measurement Systems Systems chapter 7chapter 7

Pharmacology HS140/HS140h *** Christo N. Stevens, PharmD

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JCAHO (Joint Commission on (Joint Commission on

Accreditation of Healthcare Accreditation of Healthcare Organizations)Organizations)

Created an Official “Do Not Use” ListCreated an Official “Do Not Use” List– Why?Why?

easily misinterpreted abbreviationseasily misinterpreted abbreviations

increased risk of errorsincreased risk of errors

compromised patient safetycompromised patient safety

Remember “The Five Rights” … next slideRemember “The Five Rights” … next slide

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““The Five Rights”The Five Rights”

The Five RightsThe Five Rights – Goal of healthcare Goal of healthcare

professionalsprofessionals RIGHT patientRIGHT patient RIGHT drugRIGHT drug RIGHT amount (dose)RIGHT amount (dose) RIGHT routeRIGHT route RIGHT timeRIGHT time

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Medication ErrorsMedication Errors

Medication errors … Medication errors … who can make a medication error?who can make a medication error?

– PatientPatient– PharmacistPharmacist– DoctorDoctor– Allied Health Care workersAllied Health Care workers

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Medication OrdersMedication Orders

document generated by MD in hospital / document generated by MD in hospital / inpatient setting for inpatient setting for ‘‘in-housein-house’ ’ medication medication needsneeds (for patient/resident)(for patient/resident)

Cannot be taken to an outside pharmacy Cannot be taken to an outside pharmacy to be ‘filled’to be ‘filled’

See ‘See ‘6 parts of a Medication Order6 parts of a Medication Order’ on ’ on the next slide …the next slide …

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66 parts of a parts of a Medication-Medication-OrderOrder

DATEDATE PATIENT NAME (D.O.B. recommended!)PATIENT NAME (D.O.B. recommended!) DRUG NAMEDRUG NAME DOSAGE or AMOUNT of medicationDOSAGE or AMOUNT of medication ROUTE of administration (po, IV, etc)ROUTE of administration (po, IV, etc) TIME or FREQUENCY of administration TIME or FREQUENCY of administration

(B.I.D., T.I.D., q4h, q12h, etc)(B.I.D., T.I.D., q4h, q12h, etc)

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Written Prescriptions (Rx)Written Prescriptions (Rx)

For For out-patient out-patient use use legal documentlegal document given by MD directly to given by MD directly to

the patient, or is called/faxed to pharmacy the patient, or is called/faxed to pharmacy Patient can take this to the ‘Drug Store’ Patient can take this to the ‘Drug Store’ Single-line Single-line (only 1 drug per prescription)(only 1 drug per prescription) Multiple-line Multiple-line (more than 1 drug written on (more than 1 drug written on

the same prescription-blank) the same prescription-blank)

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Common Medical Common Medical Abbreviations:Abbreviations:

RouteRoute

– IMIM =intramuscular (into muscle)=intramuscular (into muscle) Example: Depo-Provera Example: Depo-Provera ® 150 mg/mL, # 1mL ® 150 mg/mL, # 1mL

150 mg IM q 3 months150 mg IM q 3 months

– SCSC =subcutaneous (under skin)=subcutaneous (under skin) Example:Example: Lantus 100 units/mL, # 1 vialLantus 100 units/mL, # 1 vial

Inject 10 units SC q Inject 10 units SC q hshs

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Common Medical Common Medical Abbreviations:Abbreviations:

RouteRoute

– SLSL =sublingual (under the tongue) =sublingual (under the tongue) Example: nitroglycerin 0.4 mg SL tabs, #25Example: nitroglycerin 0.4 mg SL tabs, #25

i tab SL q 5 min x 3 doses prn chest i tab SL q 5 min x 3 doses prn chest painpain

– POPO =by mouth =by mouth Example: atenolol 25 mg, # 30Example: atenolol 25 mg, # 30

i tab po q ami tab po q am99

Route abbreviations Route abbreviations cont.cont.

prpr= ‘per rectum’ (insert rectally)= ‘per rectum’ (insert rectally)• RX example: RX example: Insert I suppository pr q6h prnInsert I suppository pr q6h prn• Instructing the patient to… “Insert 1 suppository per Instructing the patient to… “Insert 1 suppository per

rectum every 6 hours as needed”rectum every 6 hours as needed”

pvpv= ‘per vagina’ (insert vaginally)= ‘per vagina’ (insert vaginally)• RX example: RX example: Insert 1-gram pv qhs x 7 dosesInsert 1-gram pv qhs x 7 doses• instructing this patient to… “Insert 1-gram per vagina instructing this patient to… “Insert 1-gram per vagina

(or ‘vaginally’) at bedtime for 7 doses”(or ‘vaginally’) at bedtime for 7 doses”

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EYE (opthalmics)/EAR (otics)EYE (opthalmics)/EAR (otics)

for Eye-drops, eye-for Eye-drops, eye-ointments …ointments …

OD = Right-eyeOD = Right-eye

OS = Left-eyeOS = Left-eye

OU = both eyes, or OU = both eyes, or ‘each’ eye ‘each’ eye

For Ear-drops …For Ear-drops …

AD = Right-earAD = Right-ear

AS = Left-earAS = Left-ear

AU = both ears, or AU = both ears, or ‘each’ ear‘each’ ear

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Common Medical Common Medical Abbreviations:Abbreviations:FrequencyFrequency

acac = before meals = before meals pcpc = after meals = after meals prnprn = as needed for … = as needed for …

– prn painprn pain– prn itchingprn itching

hshs = at bedtime = at bedtime statstat = immediately, now = immediately, now

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Common Medical Common Medical Abbreviations:Abbreviations:FrequencyFrequency

q2h q2h = every 2 hours= every 2 hours q4-6h q4-6h = every 4-6 hours= every 4-6 hours b.i.d. b.i.d. = twice a day (‘b’ as in ‘= twice a day (‘b’ as in ‘bbi-ped’)i-ped’) t.i.d.t.i.d. = 3 times a day (‘t’ as in ‘ = 3 times a day (‘t’ as in ‘tthree’) hree’) q.i.d.q.i.d. = 4 times a day (‘q’ as in ‘ = 4 times a day (‘q’ as in ‘qquad’)uad’)

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Required parts Required parts of a of a Manufacturer’s Medication Manufacturer’s Medication

LabelLabel Generic & Trade Names (if Brand-drug)Generic & Trade Names (if Brand-drug) National Drug Code National Drug Code (NDC#)(NDC#) Controlled-subst classControlled-subst class(Drug-Schedule)(Drug-Schedule) Dosage / Dosage / StrengthStrength PrecautionsPrecautions Administration Administration Route Route StorageStorage Requirements (temp, etc) Requirements (temp, etc) Lot Numbers Lot Numbers and and Expiration-DatesExpiration-Dates

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genericgeneric and and TradeTrade Names Names The generic is drug’s The generic is drug’s ‘official name’ ‘official name’ in the USP.in the USP. Brand(Trade) drugs have a U.S. patent Brand(Trade) drugs have a U.S. patent and and

have the ‘®’ attached (example … have the ‘®’ attached (example … MotrinMotrin® is ® is the Brand-name, the Brand-name, ibuprofenibuprofen is generic-name) is generic-name)

Brand-names Brand-names --- are always Capitalized !--- are always Capitalized ! generic-names generic-names --- always in lower-case, and --- always in lower-case, and

drugs in the same therapeutic class almost drugs in the same therapeutic class almost always end with the same ‘suffix’ always end with the same ‘suffix’ (amoxicillin, (amoxicillin, penicillin, ampicillin …or lovastatin, simvastatin, etc)penicillin, ampicillin …or lovastatin, simvastatin, etc)

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NationalNational DrugDrug CodeCode All drugs are assigned an NDC#All drugs are assigned an NDC# to identify the to identify the manufacturemanufacture, the , the productproduct, ,

and and containercontainer--sizesize.. Always 11 digits. Always 11 digits. Format is Format is 00000-0000-00 00000-0000-00 (5-4-2) (5-4-2) first 5first 5 = the manufacturer = the manufacturer middle 4middle 4 = product (the actual drug & = product (the actual drug &

strength)strength) Last 2Last 2 =‘Pack size’ (quantity of contents) =‘Pack size’ (quantity of contents)

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NDC#NDC# 00006-0726-54 00006-0726-54

0000600006 identifies the product’s identifies the product’s manufacturer ... This is Merck & Co, Incmanufacturer ... This is Merck & Co, Inc

07260726 is the specific drug is the specific drug andand strength… … strength… … this example indicates ‘Zocor-20mg’this example indicates ‘Zocor-20mg’

5454 refers to the size of the bottle, this refers to the size of the bottle, this NDC# would be found on a 30-tab bottleNDC# would be found on a 30-tab bottle

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Controlled-Substance Controlled-Substance ‘schedule’‘schedule’

There are There are 5 schedules5 schedules (aka ‘classes’) (aka ‘classes’) Labeled with a ‘Labeled with a ‘C’ and Roman-numeral C’ and Roman-numeral

(example ‘C-III’ = a schedule-3 drug) (example ‘C-III’ = a schedule-3 drug) ‘‘Schedule’ determined by a drug’s Schedule’ determined by a drug’s

potential for dependency & abusepotential for dependency & abuse.. The The lower the number lower the number the the higher the higher the

potentialpotential for dependency and abuse. for dependency and abuse. Good examples on pg 83 in your text.Good examples on pg 83 in your text.

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Week 2 SeminarWeek 2 SeminarMeasurement Systems and Their Measurement Systems and Their

EquivalentsEquivalents

Week 2 SeminarWeek 2 SeminarMeasurement Systems and Their Measurement Systems and Their

EquivalentsEquivalents

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Assignment TipsAssignment Tips

Show your workShow your work, so I can give partial , so I can give partial credit !credit !

Turn in early Turn in early in case you need to make in case you need to make correctionscorrections

Don’t forget about Don’t forget about the Math Center the Math Center if you if you need helpneed help

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Metric SystemMetric System

Based on the Based on the decimal system decimal system the the international standard international standard for scientific for scientific

and industrial measurementsand industrial measurements Used in more than 90% of developed Used in more than 90% of developed

countriescountries

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Three Basic Units of Three Basic Units of Measure Measure in the Metric in the Metric

systemsystem WeightWeight – gram (g, gm) – gram (g, gm)

VolumeVolume – liter (L) – liter (L)

LengthLength – meter (m) – meter (m)

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Common PrefixesCommon Prefixes

DeciDeci = 0.1 (one-tenth of one unit) = 0.1 (one-tenth of one unit) CentiCenti = 0.01 (one-hundredth of a unit) = 0.01 (one-hundredth of a unit) MilliMilli = 0.001 (one-thousandth of a unit) = 0.001 (one-thousandth of a unit) MicroMicro = (one-millionth of one unit) = (one-millionth of one unit) KiloKilo = 1000 units = 1000 units

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Metric RulesMetric Rules

ZeroZero ALWAYS placed ALWAYS placed before decimal before decimal ex: ex: 0.78 0.78 (not .78)(not .78)

****If not included on assignments, this may If not included on assignments, this may be counted as incorrect !be counted as incorrect !

ZeroZero NEVER added to the end NEVER added to the end ex: 1.01 ex: 1.01 (not 1.0100)(not 1.0100)

Do Not use fractions to express values Do Not use fractions to express values …’one-tenth’ would be [0.1], not [1/10]…’one-tenth’ would be [0.1], not [1/10]

LengthLength Measurement Measurement

1 Meter = 39.37 inches1 Meter = 39.37 inches

2.5 cm = 1 inch2.5 cm = 1 inch

1 m = 1000 mm1 m = 1000 mm

1 m = 100 cm1 m = 100 cm

1 cm = 10 mm1 cm = 10 mm

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LiterLiter the metric unit of the metric unit of volumevolume

=1,000,000microliters=1,000,000microliters 1 Liter = 1L = 1,000 milliliters1 Liter = 1L = 1,000 milliliters

= 100 centi= 100 centilitersliters

=10 deci=10 decilitersliters

=0.1 deka=0.1 dekaliterliter

=0.01 hecto=0.01 hectoliterliter

=0.001 kilo=0.001 kiloliterliter

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VolumeVolume Measurement Measurement1 mL = 1cc1 mL = 1cc1 teaspoonful=5mL or 5cc’s1 teaspoonful=5mL or 5cc’s1 tablespoon=3 tsp = 15mL or 15cc’s1 tablespoon=3 tsp = 15mL or 15cc’s1 L = 32 ounces (approx)1 L = 32 ounces (approx)1L1L = = 1000 mL1000 mL==1000cc1000cc1L = 1qt (approx)1L = 1qt (approx)

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GRAMGRAM - - Metric Measure of Metric Measure of WeightWeight

= 1,000,000micrograms= 1,000,000micrograms

1 gram = (1g) = 1000 mg1 gram = (1g) = 1000 mg = 100 centigrams= 100 centigrams

= 10 decigrams= 10 decigrams

= 0.1 dekagram= 0.1 dekagram

= 0.01 hectogram= 0.01 hectogram

= 0.001 kilogram= 0.001 kilogram

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Most Common Most Common GRAMGRAM--based based unitsunits

MilliMilligram gram (mg)(mg) GramGram (g) (g) KiloKilogramgram (kg) (kg) 1000 mg =1 g1000 mg =1 g 1000 gm = 1 kilo1000 gm = 1 kilogramgram (kg or kilo) (kg or kilo)

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Weight MeasurementWeight Measurement

1 kg = 2.2 pounds1 kg = 2.2 pounds

1 kg = 1000 g1 kg = 1000 g

1 mg = 0.001g1 mg = 0.001g

1 mg = 1000 mcg or µg 1 mg = 1000 mcg or µg

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Apothecary SystemApothecary System

Old measurement system for calculating Old measurement system for calculating drug ordersdrug orders

1 drop (gtt) of water = 1 minim (ɱ)1 drop (gtt) of water = 1 minim (ɱ) 60 minims(60gtts) = 1 fluid dram (f60 minims(60gtts) = 1 fluid dram (fӠӠ)) 1 grain = approximately the weight of 1 1 grain = approximately the weight of 1

grain of wheat or rice = 60mg …grain of wheat or rice = 60mg … Bottom-line! Bottom-line! 1-grain = 60-mg1-grain = 60-mgGrain apothecary examples: Grain apothecary examples: [gr i = 60mg] or [gr ii = 120mg] or [gr [gr i = 60mg] or [gr ii = 120mg] or [gr

ss = 30mg] or [gr iss = 90mg] …’ss’ means ‘1/2’ !!ss = 30mg] or [gr iss = 90mg] …’ss’ means ‘1/2’ !!

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HouseholdHousehold System System

VolumeVolume– 1 cup (c) = 8 oz1 cup (c) = 8 oz– 1 pint (pt) = 2 c = 16 oz1 pint (pt) = 2 c = 16 oz– 1 quart (qt) = 2 pt = 4 c =32 oz1 quart (qt) = 2 pt = 4 c =32 oz– 1 gallon (gal)= 4 qt= 8 pt = 16c = 128oz1 gallon (gal)= 4 qt= 8 pt = 16c = 128oz

WeightWeight or mass or mass– 1 pound = 16 oz1 pound = 16 oz

LengthLength– 1 foot = 12 in1 foot = 12 in– 1 yard = 3ft = 36in 1 yard = 3ft = 36in

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