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<body> <div id="content"> <div align="center" class="style3"> <?php echo $L3picture; ?> <h1><?php echo $L3title; ?></h1> </div> <div class="style3">There are two different ways in which drugs can be administered, often referred to as <strong>routes</strong>. Drugs may be given <strong>orally</strong>, by mouth, or injected; medications that are injected are called <strong>parenteral medication</strong>. </div> <div class="style3"> <h2><a name="oral"></a>Oral Medications </h2> <p>Many medicines are given by mouth. <strong>The abbreviation for medication to be given by mouth is p.o.</strong>, which is an abbreviation of the Latin phrase "per os," meaning "by mouth." </p> <p>Oral medications generally come in 3 forms: tablets, capsules, and liquid. <strong>Tablets</strong> are pills that are solid; <strong>tablets can be split in half if they have a score</strong>, or line, in the middle of them. However tablets <strong>cannot</strong> be cut into smaller pieces such as thirds or fourths. Here is a sample picture of some tablets (notice the score down the middle of the one at the left, where it can be cut in half):</p> <p align="center"><img src="tablets.jpg" width="110" height="82"> <br> <font size="-2">tablets</font></p> <p><strong>Capsules</strong> are pills that contain liquid or powder, usually in some kind of gelatin cover; <strong>capsules can never be broken into smaller pieces</strong> because the power or liquid they contain would fall out; <strong>therefore doses of capsules must always be in whole numbers</strong>. Below are a few pictures of different kinds of capsules: </p> <center><table><tr><td><center><img src="capsules.jpg" width="135" height="107"></center></td> <td><center><img src="vitaminE.jpg" width="110" height="82"></center></td> <tr><td> <div align="center"><font size="-2">capsules containing<br> powder </font> </p> </div></td> <td><div align="center"><font size="-2">capsules containing<br> liquid </font> </p> </div></td></tr> </table> </center> <p>Not all oral medication comes in pill form, however. Many oral medications are given as <strong>liquids</strong>. Oral medication for small children or infants will generally be in liquid form, since they cannot swallow pills. Below are photographs of some of the containers often used for dosage of liquid oral drugs:</p> <center><table><tr><td><center><img src="oralsyringe.jpg" width="214"> </center></td> <td><center><img src="oralsyringe2.jpg" width="207"> </center></td> <td><center><img src="usingoralsyringe.gif"></center></td> <td><center><img src="dropper.jpg" width="260"> </center></td> <td><center><img src="dosagespoon.jpg" width="219"> </center></td> <td><center><img src="medcup.jpg" width="238"> </center></td> <tr><td> <div align="center"><font size="-2">an oral syringe</font> </div> <td><div align="center"><font size="-2">another kind of oral syringe</font></div></td> <td><div align="center"><font size="-2">using an oral syringe<br>to dose an infant</font></div></td> <td><div align="center"><font size="-2">a calibrated oral dropper</font></div></td> <td><div align="center"><font size="-2">a calibrated medicine spoon</font></div></td> <td><div align="center"><font size="-2">a calibrated medicine cup</font></div></td></tr> </table> </center> <p>Adults generally take liquid oral medication by using a calibrated medicine cup of some kind, but droppers, spoons, and oral syringes are often used for dosing small children and infants who may not be able to drink from a cup. It is also important to note that <strong>you should never use an oral syringe to give injectable medication, because oral syringes are not sterile.</strong></p> <div><h2><a name="parenteral"></a>Parenteral Medications</h2> <h3>Routes of Administering Parenteral Medications</h3> <p><strong>Parenteral medications</strong> are any medications given by <strong>injection</strong>. Injection is usually given in one of three different ways: <ul> <li> <p><span class="style5"><strong>Subcutaneously</strong> (<strong>s.q.</strong>)</span>: A <strong>subcutaneous</strong> injection is one that is given in the fatty layer of tissue under the skin. <strong>The maximum amount of fluid an adult can safely be given subcutaneously is 1 mL</strong>.</p> </li> <li> <p><span class="style5"><strong>Intramuscularly</strong> (<strong>IM</strong>)</span>: An <strong>intramuscular</strong> injection is one that is given in the muscle. <strong>The maximum amount of fluid an adult can safely be given intramuscularly is 3 mL; for a child, the maximum is 1 mL</strong>. </p> </li> <li> <p><span class="style5"><strong>Intravenously </strong>(<strong>IV</strong>)</span>: An <strong>intravenous</strong> injection is one that is given directly into the vein. Much higher amounts of fluids can be given intravenouly; in fact, the limit on the amount of fluid that can be given intravenously is generally only capped by the limit on the amount of fluid a patient can take in each day (for a healthy patient this range is usually 35-50 mL/kg body weight/day, but this amount can vary greatly depending upon the condition of the patient). </p> </li> </ul> <p>Note the abbreviations for <strong>subcutaneously</strong>, <strong>intramuscularly</strong>, and <strong>intravenously</strong>: <strong>s.q</strong>., <strong>IM</strong>, and <strong>IV</strong>, respectively. We will wait until later lectures to learn in depth about IV medication; for the moment, we will give s.q., IM, and IV medications using syringes only. </p> <h3><a name="syringetype"></a>Types of Syringes Used for Parenteral Medication</h3> <p>There are several different sizes of syringes that might be used for medication. You should always use the <strong>smallest possible syringe in which the dosage will fit</strong>, because <strong>the smaller the syringe, the more accurately you can measure the dosage</strong>:</p> <ul> <li> <p><span class="style5"><strong>3 cc syringe</strong></span>: This is the most commonly used syringe. As it's name suggests, it holds a<strong> total of 3 cc (3 mL)</strong> of fluid. Every <strong>tenth of a cc(mL)</strong> is marked on the syringe, and every half cc(mL) is labeled; this means that any dosage we plan to measure using a 3 cc syringe should be <strong>rounded to the nearest tenth</strong>. </p> <p>Dosages <strong>between 1-3 mL</strong> should always be measured in a 3 cc syringe. </p> <p>Some 3 cc syringes have the cc (mL) scale to the right and a minim scale to the left; <strong>be careful not to measure mL or cc on the minim scale</strong>, as this will result in an incorrect dosage! <br> <center><table><tr><td><center> <img src="3ccsyringeminim.JPG" width="144" height="567"> </center></td> <td><center> <img src="3ccsyringe.jpg" height="569"> </center></td> <tr><td> <div align="center"><font size="-2">3 cc syringe with<br> minims marked on the left </font> </p> </div></td> <td><div align="center"><font size="-2">3 cc syringe without<br> minims marked </font> </p> </div></td></tr> </table> </center> </p></li> <li> <p><span class="style5"><strong>Tuberculin syringe</strong></span>: A tuberculin syringe is used to measure <strong>small doses</strong>, so it is often used to dose small children and infants. It can hold a total of <strong>1 cc (mL)</strong>; every <strong>hundredth of a cc (mL)</strong> is marked on a tuberculin syringe, and every fifth of a cc (mL) is labeled; this means that any dose we plan to administer with a tuberculin syringe should be <strong>rounded to the nearest hundredth</strong>. </p> <p><strong>Any dose smaller than 0.5 mL should be measured using a tuberculin syringe</strong>, and any dose less than 1 mL can be more accurately measured using a tuberculin syringe. Because a tuberculin syringe has every hundredth of a mL marked whereas the 3 cc syringe has only every tenth of a mL marked, it is possible to measure doses with more accuracy in a tuberculin syringe. </p> <p align="center"><img src="tuberculin.jpg"> <br> <font size="-2">tuberculin syringe</font></p> <li> <p><span class="style5"><strong>5-12 cc syringes</strong></span>: When an IV dose requires a syringe that can hold more than 3 mL, a 5, 6, 10, or 12 cc syringe can be used. On each of these size syringes, <strong>every 0.2, or two tenths, is marked</strong>, so <strong>be very careful not to misread a mark as one tenth of a cc</strong>! </p> <p>Dosages between 3-12 mL should be measured using one of these syringes; always choose the smallest possible syringe in which the dose will fit to ensure the highest level of accuracy.</p> <center><table><tr><td><center> <img src="5ccsyringe.jpg" width="160" height="320"> </center></td> <td><center> <img src="6ccsyringe.jpg" width="150" height="293"> </center></td> <td><center> <img src="10ccsyringe.jpg" width="82" height="360"> </center></td> <td><center> <img src="12ccsyringe2.jpg" width="150" height="291"> </center></td> </tr> <tr> <td><div align="center"><font size="-2">5 cc syringe </font></div></td> <td><div align="center"><font size="-2">6 cc syringe </font></div></td> <td><div align="center"><font size="-2">10 cc syringe </font></div></td> <td><div align="center"><font size="-2">12 cc syringe </font></div></td> </tr> </table> </center> </li> <li> <p><span class="style5"><strong>20 cc (or more) syringes</strong></span>: Occasionally it is necessary to use even larger syringes to measure IV fluids. In this case there are syringes that can measure a maximum of 20 cc or more; these syringes only have <strong>every mL</strong> marked. </p> <p>Any dosage above 12 mL must be measured using a 20 cc syringe or larger.</p> <p align="center"><img src="20ccsyringe.jpg"><br> <font size="-2">20 cc syringe syringe</font></p> </li> <li><p><span class="style5"><strong>Tubex and Carpuject cartridges</strong></span>: These are special <strong>pre-filled</strong> cartridges produced by two specific companies that can be dropped into a plastic injector with a plunger for injection. The ones we will encounter in this class will have markings every tenth of a mL and will contain up to 2.5 mL of fluid.</p> <center><table><tr><td><center><img src="tubex.jpg"> </center></td> <td><center><img src="carpuject.jpg"></center></td> <tr><td> <div align="center"><font size="-2">Tubex cartridge</font> </p> </div></td> <td><div align="center"><font size="-2">Carpuject cartridge</font> </p> </div></td></tr> </table> </center> </li> </ul> </div> <h3><a name="syringeexample"></a>Measuring Dosages in a Syringe</h3> <p>To measure a dosage in a syringe, we must line up the <strong>top</strong> of the black rubber plunger exactly with the line that marks the dosage we want to administer. </p> <h4>Example:</h4> <p><img src="3ccsyringe.jpg" style="float:left"> <div>If we look closely, we can see that this syringe has the top of the black rubber stopper lined up with the third mark past the 2. Since this is a 3 cc syringe and has every <strong>tenth of a mL </strong> marked, that means that we are three tenths past 2, which is a total of <strong>2.3 mL</strong>. </div> </p> <div style="clear:both"></div> <h4>Example:</h4> <p><img src="3ccsyringeminim.jpg" style="float:left"> <div>If we look closely, we can see that this syringe has the top of the black rubber stopper lined up with the first mark past the 1/2 which follows the 2. Since this is a 3 cc syringe and has every <strong>tenth of a ML </strong> marked, that means that we are one tenth past 2.5, which is a total of <strong>2.6 mL</strong>. </div> </p> <div style="clear:both"></div> <h4>Example:</h4> <p><img src="6ccsyringe.jpg" style="float:left"> <div>If we look closely, we can see that this syringe has the top of the black rubber stopper lined up with the third mark past the 4. Since this is a 6 cc syringe and has every <strong>0.2 mL </strong> marked, that means that we are three 0.2s past 4, which is a total of <strong>4.6 mL</strong>. </div> </p> <div style="clear:both"></div> <h4>Example:</h4> <p><img src="12ccsyringe2.jpg" style="float:left"> <div>If we look closely, we can see that this syringe has the top of the black rubber stopper lined up with the second mark past the 10. Since this is a 12 cc syringe and has every <strong>0.2 cc </strong> marked, that means that we are two 0.2s past 10, which is a total of <strong>10.4 mL</strong>. </div> </p> <div style="clear:both"></div> <h4>Example:</h4> <p><img src="20ccsyringe.jpg" style="float:left"> <div>If we look closely, we can see that this syringe has the top of the black rubber stopper lined up with the second mark past the 10. Since this is a 20 cc syringe and has every <strong>whole mL </strong> marked, that means that we are two whole mL past 10, which is a total of <strong>12 mL</strong>. </div> </p> <div style="clear:both"></div> <h4>Example:</h4> <p><img src="tuberculin.jpg" style="float:left"> <div>If we look closely, we can see that this syringe has the top of the black rubber stopper lined up with the third mark past the .60. Since this is a tuerculin syringe and has every <strong>hundredth of a mL </strong> marked, that means that we are three hundredths of a mL past 0.6, which is a total of <strong>0.63 mL</strong>. </div> </p> <div style="clear:both"></div> </div> <div> <div class="style3"><h2>Reading Medication Labels and Calculating Dosages </h2> <h3><a name="readlabel"></a>Reading Medication Labels </h3> <p>Before we can even begin to calculate how much medicine to give a patient, we must be able to read a medication label correctly. There are several important pieces of information we should look for whenever we look at a medication label: <ol> <li> <p><span class="style5"><strong>Name</strong> of the medication</span><br> There are actually at least two names on every medication label: </p> <ul> <li> <p>The <strong class="style5">trade name</strong> is the name assigned to the drug by the manufacturer and it <strong>varies from one company to another</strong>. A single drug may have many different trade names if it is manufactured and sold by many different companies. The trade name of a drug is usually <strong>capitalized</strong>. <br> For example, you may be familiar with the over-the-counter pain relievers Advil and Motrin. These are actually two different brand names for the same drug that is manufactured by two different companies. </p> </li> <li> <p>The <strong class="style5">generic name</strong> is the name assigned to the drug officially in the United States. There is only one generic name for each drug, and all drug labels must list the drug's generic name in addition to any trade names so that the drug can be identified by its offical name. The generic name of a drug is generally written in <strong>lower case letters</strong>. <br> So, Motrin and Advil are trade names that each refer to the same drug, and its offical generic name is ibuprofen. If you look closely at a bottle of Advil or Motrin, you will see that the labels on each bottle state that they contain ibuprofen. </p> </li> </ul> <p><strong>A drug may be ordered by its brand name or by its generic name</strong>, so it is very important to pay attention to both kinds of drug names so that you can identify a drug by either one when it is ordered. </p> </li> <li> <p><strong class="style5">Dosage units</strong><br> These are units which are used to measure the drug's weight or action and are the <strong>units used whenever an order is written for the drug</strong>.<br> The most common <strong>dosage units</strong> are <strong>milligrams, grams, micrograms, grains, Units</strong> and <strong>milliequivalents</strong>. <br> </p> </li> <li> <p><strong class="style5">Administration units</strong><br> These are units which are used to measure the drug for <strong>actual administration to the patient</strong>. <br> Because it would be very difficult to measure a drug by it's weight or action, <strong>we usually measure drugs by their volume or by counting a number of tablets or capsules when we actually want to take out the exact amount we want to give the patient</strong>. <br> The most common <strong>administration units</strong> are <strong>tablets, capsules, teaspoons, tablespoons, ounces, drops, liters, and milliliters</strong>. </p> </li> <li> <p><span class="style5"><strong>Concentration</strong> or <strong>Dosage strength</strong></span><br> This tells us <strong>what the relationship is between the dosage units and the administration units</strong>. <br> Because almost all drugs are <strong>ordered in dosage units</strong> but <strong>administered in administration units</strong>, <strong>we must have a way to convert from one set of units to the other</strong>; this is what the concentration of a drug allows us to do. </p> </li> <li> <p><strong class="style5">Total amount</strong> of the drug contained in the package<br> This is exactly what it sounds like: the total number of dosage units or administration units contained in a particular package of the drug. </p> </li> <li> <p><strong class="style5">Expiration date</strong><br> All drugs have an expiration date on them, usually prefaced by the abbreviation <strong>EXP.</strong>; <strong>you should always check that the current date is before the drug's expiration date before you give a drug to a patient</strong>. </p> </li> </ol> <h3><a name="labelexample"></a>Sample Medication Labels</h3> <p>To better understand the different pieces of information on a drug label, let's look at a few examples:</p> <h4>Example:</h4> <p><img src="verelan.jpg"></p> <p><ol> <li> <p>Trade name: Verelan<br> Generic name: verapamil HCl</p> </li> <li> <p>Dosage units: mg </p> </li> <li> <p>Administration units: cap </p> </li> <li> <p>Concentration: Each capsule is 120 mg. <br> Notice that the label just says 120 mg, but does not say whether this is the amount for a single pill or for the whole package; <u>for packages containing <strong>pills</strong>, a single dosage like this <strong>always</strong> represents the <strong>amount per pill</strong>. Be careful though, because if a medicine is measured <strong>by volume</strong>, <strong>a single dosage represents the total amount in the package</strong>, <strong>NOT the amount per mL</strong>.</u> </p> </li> <li> <p>Total amount in the package: 100 capsules</p> </li> </ol> </p> <h4>Example:</h4> <p><img src="thorazine.jpg"></p> <p><ol> <li> <p>Trade name: Thorazine<br> Generic name: chlorpromazine HCl</p> </li> <li> <p>Dosage units: mg </p> </li> <li> <p>Administration units: mL </p> </li> <li> <p>Concentration: 25 mg/mL<br> This means that there are 25 mg in each 1 mL. <br> </p> </li> <li> <p>Total amount in the package: 10 mL</p> </li> </ol> <p></p> <h4>Example:</h4> <p><img src="procan.jpg"></p> <p><ol> <li> <p>Trade name: Procan SR <br> Generic name: procainamide HCl</p> </li> <li> <p>Dosage units: mg <br> This one is a little tricky because the label does not actually state what the units are! However, because mg are the most commonly used units for drug dosages, we are supposed to assume that the 750 on the label means 750 mg. If we are uncertain, we should look inside the package for the package insert, which should state the dosage information in more detail. </p> </li> <li> <p>Administration units: tab </p> </li> <li> <p>Concentration: Each capsule is 750 mg. <br> Notice that the label just says 750, but does not say whether this is the amount for a single pill or for the whole package; <u>for packages containing <strong>pills</strong>, a single dosage like this <strong>always</strong> represents the <strong>amount per pill</strong>. Be careful though, because if a medicine is measured <strong>by volume</strong>, <strong>a single dosage represents the total amount in the package</strong>, <strong>NOT the amount per mL</strong>.</u> </p> </li> <li> <p>Total amount in the package: this label does not say - we may need to look at the package insert to find this information if we really want to know </p> </li> </ol> </p> <h4>Example:</h4> <p><img src="cleocinphosphate.jpg"></p> <p><ol> <li> <p>Trade name: Cleocin Phosphate <br> Generic name: clindamycin phosphate </p> </li> <li> <p>Dosage units: mg </p> </li> <li> <p>Administration units: mL </p> </li> <li> <p>Concentration: 900 mg per 6 mL <br> The label does not phrase it exactly this way, but if we look closely, we see that the label says that this package contains <strong> 900 mg</strong>. Because this is a <strong>liquid</strong>, and <strong>not in pill form</strong>, we know that this stands for the amount in the <strong>whole package</strong>. So in order to find out how many mg are in a mL: we already know the number of <strong>mg</strong> in the <strong>whole package</strong>, so now we need to see how many <strong>mL</strong> there are in the <strong>whole package</strong> - if we look closely at the top we see that this package contains one vial that holds <strong>6 mL total</strong>. So there are <strong>900 mg per 6 mL</strong>. (If we wanted to, we could simplify this to 150 mg/mL by dividing both numbers by 6, but we don't have to do this unless we want to.) </p> </li> <li> <p>Total amount in the package: 900 mg, 6 mL <br> Notice that this package gives us the total number of dosage units <strong>and</strong> the total number of administration units. In other words, it gives us <strong>two different ways to measure the same total amount of drug in the package</strong>. There is a total of 900 mg of the drug in this package; with this particular drug in its given concentration mix, this is the <strong>same</strong> thing as saying that there are 6 mL of this drug in the package because every 6 mL of this drug contains 900 mg of Cleocin Phospate - <strong>one of these measurements measures the mass of the drug itself</strong>, and the <strong>other one of these measurements measures the volume of the drug in liquid form</strong>. </p> </li> </ol> </p> <h3><a name="dosageexample"></a>Calculating the Amount of a Drug Needed to Administer a Particular Dosage</h3> <p>When a patient is given an order for a particular drug, <strong>that order almost always requests the drug in dosage units</strong> such as milligrams, grams, micrograms, grains, Units and milliequivalents. However, to actually measure out the medicine and give it to the patient, we cannot measure milligrams, grams, micrograms, grains, Units and milliequivalents; instead <strong>we need to measure the drug by taking out the correct number of pills or the correct volume of the liquid</strong> to give to the patient. </p> <p>So, we need to <strong>convert dosage units to administration units</strong> before we can give a patient any medication. To see how we might calculate this, we look at several examples: </p> <?php include('./generateEXdosage.php'); ?> </div> </div> </div> </body> </html>