© 2012 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 13 Oral Dosages PowerPoint ® Presentation to accompany: Math and Dosage Calculations

© 2012 The McGraw-Hill Companies, Inc. All rights reserved.

Chapter 13 Oral Dosages

PowerPoint® Presentation to accompany:

Math and Dosage Calculations for Healthcare ProfessionalsFourth Edition

Booth, Whaley, Sienkiewicz, and Palmunen

13-2


13.1 Demonstrate administration of solid oral medications.

13.1a. Calculate dosages for solid oral medications.

13.1b. Explain principles related to administration of solid oral medications.

Learning Outcomes

13-3


13.2 Demonstrate administration of liquid oral medications.

13.2a. Calculate dosages for liquid oral medications.

13.2b. Explain principles related to administration of liquid oral medications.

Learning Outcomes

13-4


Key Terms Caplet

Capsule

Enteric-coated

Gelcap

Reconstitution

Scored

Spansules

Sustained release

Tablet

13-5


Introduction

You will apply:

the simple calculation methods learned in Chapter 12 to oral dosages;

the principles of label reading learned in Chapter 10.

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Introduction (cont.)

Use the method of calculation that you have chosen.

Remember that excellence is a must with dosage calculations.

13-7


Oral Solid Medications

Solid oral medications come in several forms.

Tablets Caplets Capsules Gelcaps

13-8


Oral Solid Medications (cont.)

Tablets Combination of an amount of drug with

inactive ingredients

Administration forms Oral (swallow) Sublingual Buccal Chewable Dissolvable

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Caplets

Oval-shaped

Made with a special

coating that makes them

easier to swallow

Tylenol caplets

Tylenol caplets

Tylenol caplets

Tylenol caplets

Tylenol caplets

Tylenol caplets

500 mg

500 mg

500 mg500 mg

500 mg

500 mg

Tylenol caplets

Tylenol caplets

500 mg

500 mg

13-10



Capsules

Oval-shaped gelatin shells containing medication in powder or granule form

13-11



Gelcaps A liquid medication

in a gelatin shell

Not designed to be opened

13-12



Scored tablets Score allows the tablet to be divided

when smaller doses are ordered. Most often, scored tablets divide

into halves.

Some divide into thirds or quarters.

13-13


Calculating Dosages –Oral Solid Medications

Rule 13-1Rule 13-1

Always question and/or verify when your calculation indicates to give a portion of a tablet when the tablet is not scored.

Never attempt to break a tablet that is not scored.

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Calculating Dosages –Oral Solid Medications (cont.)

Rule 13-2 Rule 13-2 Question and recheck any calculation that indicates that you should administer more than three tablets or capsules.

13-15



Rule 13-3 Rule 13-3 Follow these steps when determining the amount of medication to administer to a patient:

Step A Convert

Step B Calculate

Step C Think! . . . Is It Reasonable?

If necessary, recheck calculation.

13-16



The order is to give the patient 15 mg mirtazapine PO now.

On hand: 30 mg scored tablets

Calculate the correct amount of medication to administer using method of choice.

13-17



H = 30 mg ; Q = 1 scored tablet; D = 15 mg

Step A Convert

No conversion is necessary.

13-18



Step B Proportion H/Q = D/A or H:Q = D:A30 mg/1 tab = 15 mg/A

30 x A = 1 tab x 15

30A/30 = 15 tab/30

A = 0.5 tab = 1/2 tab

13-19



Step B Dimensional analysis

A = Q/H x D/1

A tab = 1 tab/30 mg x15 mg/1

A tab = 15 tab/30

A tab = 0.5 tab = 1/2 tablet

13-20



Step B Formula Method

15mg/30 mg x 1 tab = A

15 tab/30 = A

0.5 tab = 1/2 tablet = A

AxQHD

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15 mg is one-half of 30 mg, so 1/2 tablet is an appropriate answer.

Tablets are scored, so 1/2 tablet can be given.

13-22


Error Alert

Observe patients as they take their medications.

Leaving medications at the bedside leads to errors.

13-23


Crushing Tablets or Opening Capsules Who benefits?

Patients who have difficulty swallowing pills Patients who have tube feedings

Check the policy May need physician

order first

13-24


Crushing Tablets or Opening Capsules (cont.)

When mixing with food prepare tablet or

capsule; mix with soft foods or

liquids.

Check for interactions before mixing.

13-25


Some Common Food and Drug Interactions

DRUG FOOD INTERACTION

Antipsychotics Coffee and tea Reduced effectiveness of drug

Bronchodilators Caffeine Stimulation of the nervous system

CNS depressants Black cohosh, ginseng, kava kava, St. John’s wort, valerian, ETOH

Intensified sedative effects of drug

Erythromycin Acidic fruits, juices, carbonated beverages

Decreased antimicrobial activity

13-26


Some Common Food and Drug Interactions (cont.)


Ferrous sulfate

Tea Decreased absorption

Haloperidol Coffee and tea Decreased absorption

Insulin Coffee Stimulated excretion

MAO inhibitors Foods with tryamine (hard cheeses, chocolate, red wine, and beef or chicken liver)

Headache, nosebleed,

chest pain, severe hypertension

13-27



Tetracyclines Dairy products Reduced effectiveness of the drug

Antihistamines, cholesterol lowering agents, calcium channel blockers

Grapefruit and grapefruit juice

Muscle aches, fatigue, increase in side effects

Some Common Food and Drug Interactions (cont.)

13-28



Tube feedings Dissolve the crushed tablet or opened

capsule in a small amount of warm water.

If medication cannot be crushed check for an alternative form;

ask the physician to change the order.

13-29



Enteric-coated tablets:

deliver medication that would be destroyed by the stomach acid or that could injure the stomach lining;

must never be crushed, broken, or chewed.

13-30



Sustained-Release Medications Drug is released slowly into the

bloodstream.

Do not crush or dissolve – this allows too much medication to be absorbed at one time.

13-31



Spansules contain granules of medication with

different coatings that delay release of some of the medication;

may be opened and the granules gently mixed with soft food.

13-32



Rule 13-4Rule 13-4 To prevent an incorrect dose of medication, do not crush or otherwise alter any of the following:

enteric-coated tablets;

sustained-release forms of medication;

any tablet with a hard shell or coating;

13-33



Rule 13-4 Rule 13-4 (cont.)

any tablet with layers or speckles of different colors;

tablets for sublingual or buccal use;

capsules with seals that prevent separating the two parts.

13-34


Indication of sustained-release drugs:-Bid LA Tempule

-Dur CR Chronotab

Plateau Cap XL Repetab

Span Sequel Tembid

SA Spansule

SR Extentab


13-35



Indication of enteric-coated drugs:

EC

Enseal

13-36


Patient Education Determining how many pills to take

Perform necessary calculations first.

Determining whether or not to take with food Drink at least 8 oz of water

with any medication.

13-37


Patient Education (cont.)

Divided tablets Pharmacist can provide service of dividing

the tablets.

If patient will do dividing himself, he should:

wash his hands; break tablet along scored line; use a knife or pill cutter.

13-38



If patients have difficulty swallowing, they can drink water before taking pills;

place whole tablet or capsule in food;

crush tablets. Place between two spoons. Use pill crusher.

13-39


Practice

Ordered: Ploglitazone HCl 45 mg po

On hand: see label (unscored tablet)

What is the amount to administer?

What action should you take?

ANSWER: 1 1/2 tablet

ANSWER: Do not break tablet; check for another dose; contact physician.

13-40


Practice

Ordered: Alpraxolam 1.5 mg po q 6 h

On hand: see label (scored into fourths)


What action do you take?

ANSWER: ¾ tablet

ANSWER: break tablet and administer 3/4 tablet

13-41


Liquid Oral Medications

Greater range of dosages possible

Easier to swallow For children For the elderly

13-42


Liquid Oral Medications (cont.)

May be less stable so provided in powdered form

See directions for reconstitution Label Package insert

Follow requirements for

refrigeration

13-43



Rule 13-5 Rule 13-5 Reconstituting Liquid Medications:

Use only the liquid specified on label.

Use the exact amount of liquid specified.

Check the label – medication may need to be shaken before administering.

13-44




Check the label – is refrigeration of reconstituted medication needed?

Write on the label Date and time of reconstitution Your initials Dosage strength

13-45



Reconstitute to the strength that will allow the desired dose in the smallest volume.

Read the order carefully when calculating the amount to administer.


Return to Pt Ed Slide 53

13-46



To calculate the volume of liquid oral medication to administer, use: proportion

formula

dimensional analysis

QHD

A

13-47



Find the amount to administer.

Ordered: Granisetron 5 mg PO now On hand: Granisetron 2 mg per 10 mL oral

solution

Use the calculation method of choice.

13-48


Calculating Dosages –Liquid Oral Medications (cont.)

H = 2 mg ; Q = 10 mL; D = 5 mg

Step A Convert

No conversion is necessary.

13-49



Step B Proportion H/Q = D/A or H:Q = D:A2 mg/10 mL = 5 mg/A

2 x A = 10 mL x 5

2A/2 = 50 mL/2

A = 25 mL

13-50



Step B Dimensional analysis

A = Q/H x D/1

A mL = 10 mL/2 mg x5 mg/1

A mL = 50 mL/2

A mL= 25 mL

13-51



Step B Formula Method

5mg/2mg x 10 mL = A

50 mL/2 = A

25 mL = A

AxQHD

13-52




5 mg is two and one-half times 2 mg, and 25 mL is 2.5 times 10 mL, so it is a reasonable amount.

13-53


Patient Education

Review steps for reconstitution of medications. Follow Rule 13 -5.

Read the label to learn how to store the medication.

To Rule 13-5

13-54


Patient Education

Use the measuring device provided or a device specifically made for measuring medications.

Household teaspoons and tablespoons do not always measure liquids accurately.

13-55



Do not store medication longer than the label indicates.

It may lose potency.

Its chemical composition may change.

13-56



Wash measuring device after each use. Use hot water and dish detergent. Dry thoroughly. Store in clean container.

Keep liquid medication in original container.

13-57


Practice

What liquid is used to reconstitute this medication?

How much liquid is added?

What, if any, are the additional instructions?

ANSWER: water

ANSWER: 154 mL

ANSWER: shake vigorously after adding water

13-58


Practice

Ordered: Erythromycin oral suspension 0.5 g po q6 h

On hand: see label (prior slide)


ANSWER: 12.5 mL

13-59


In Summary

In this chapter you learned to

demonstrate administration of solid oral medications bya. calculating dosages;

b. explaining related principles.

13-60


Apply Your KnowledgeTrue or False___ Any tablet can be broken in half to give a

patient the correct dose.

___ Enteric-coated tablets can be crushed and given through an NG tube.

___ Some spansules can be pulled apart so the granules can be given with applesauce.

T

F

FOnly scored tablets should be broken.

Medication could be broken down by stomach acid, or it could injure the stomach lining.

13-61


Apply Your Knowledge

Which of the following foods are contraindicated to mix with tetracyclines?

A. Water

B. Orange juice

C. Milk

D. Applesauce

13-62



Which of the following types of medications may be crushed for administration?

A. Scored tablets

B. Enteric-coated tablets

C. Sustained-release tablets

D. Spansules

13-63



What preparation must be done before administering a crushed medication through a nasogastric tube?

A. Nothing special is needed.

B. Mix the medication with applesauce.

C. Mix the medication with warm water.

D. Mix the medication with ice cream.

13-64



What is an advantage of liquid oral medications?

How do you find out what and how much you should use to reconstitute a medication in powder form?

ANSWER: read the label or the package insert

ANSWER: greater range of dosages can be ordered and administered

13-65


Apply Your KnowledgeTrue or False___ You must write only the date and time you

reconstituted the medication on the label..

___ The physician will only order doses of liquid oral medications in volume of liquid.

___ When reconstituting a medication, select a strength that will provided the desired dose in the smallest volume.

T

F

F

You also have to write your initials and strength, if needed.

Medications are usually ordered in units of drug, rather than volume.

13-66


End of Chapter 13

If you want to

achieve

excellence,

you can get

there today.

As of this

second,

quit doing

less-than-

excellent work.

-- Thomas John

Watson, Jr.

Documents

© 2012 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 13 Oral Dosages PowerPoint ® Presentation to accompany: Math and Dosage Calculations