Week 2-Week 2- Medication Orders Medication Orders

andandMeasurement SystemsMeasurement Systems

Jack Lazarre, Pharm.D.

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Medication Order IssuesMedication Order Issues

Are you expected to know everything?Are you expected to know everything?– No healthcare professional isNo healthcare professional is

TipTip Obtain a good, current referenceObtain a good, current reference When in doubt askWhen in doubt ask

– No silly questions related to patient safetyNo silly questions related to patient safety

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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”Remember “The Five Rights”

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““Do Not Use” List ExamplesDo Not Use” List Examples

DON’TDON’T

1. “u” or “IU” for units

2. “q.d." "qd" "Q.D." "QD“

3. “Q.O.D.”

DODO

1. Spell out the word “units”

2. Spell out the word “daily”

3. Spell out “every other day”

The Joint Commission on Accreditation of Healthcare Organizations. The Joint Commission on Accreditation of Healthcare Organizations. The The Official “Do Not Use Official “Do Not Use List”.Retrieved September 29, 2007, List”.Retrieved September 29, 2007, http://www.jointcommission.org

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““Do Not Use” List ExamplesDo Not Use” List Examples DON’TDON’T

1. Trailing zero – “5.0 mg”

1. Decimal point without a leading zero

– “.5” can be mistaken for “5”

DODO

1. Avoid the use of a zero after a decimal point

– “5”

2. Use a leading zero before a decimal

– “0.5”

The Joint Commission on Accreditation of Healthcare Organizations. The Joint Commission on Accreditation of Healthcare Organizations. The The Official “Do Not Use Official “Do Not Use List”.Retrieved September 29, 2007, List”.Retrieved September 29, 2007, http://www.jointcommission.org

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Common Medical Common Medical Abbreviations:Abbreviations:

RouteRoute RouteRoute

– IMIM intramuscularintramuscular Example: Depo-Provera Example: Depo-Provera ® 150 mg/mL, # ® 150 mg/mL, #

1mL 1mL

150 mg IM q 3 months150 mg IM q 3 months

– SCSC subcutaneoussubcutaneous 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 RouteRoute

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

#25#25i tab SL q 5 min x 3 doses prn i tab SL q 5 min x 3 doses prn

chest painchest pain

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

i tab po q ami tab po q am77

Common Medical Common Medical Abbreviations:Abbreviations:

RouteRoute IVIV intravenousintravenous p.r.p.r. per rectumper rectum p.v.p.v. per vaginaper vagina

O.D. Right eye

O.S. Left eye

O.U. Both eyes

A.D. right ear

A.S. left ear

A.U. both ear

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Common Medical Common Medical Abbreviations:Abbreviations:

FrequencyFrequency

a.c.a.c. before mealsbefore meals p.c.p.c. after mealsafter meals prnprn as needed; as needed;

as needed foras needed for– prn painprn pain– prn HAprn HA

h.s.h.s. at bedtimeat bedtime statstat immediatelyimmediately

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Common Medical Common Medical Abbreviations:Abbreviations:

FrequencyFrequency

q 2hq 2hevery 2 hoursevery 2 hours q 4-6hq 4-6h every 4-6 hoursevery 4-6 hours

b.i.d.b.i.d. twice a daytwice a day t.i.d.t.i.d. three times a daythree times a day q.i.d.q.i.d. four times a day four times a day

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Questions?Questions?

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Required InfoRequired Info

Manufacturer’s LabelManufacturer’s Label

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Parts of a Manufacturer’s Parts of a Manufacturer’s Medication LabelMedication Label

Generic and Trade NamesGeneric and Trade Names National Drug CodeNational Drug Code Controlled Substances Drug SchedulesControlled Substances Drug Schedules Dosage StrengthDosage Strength PrecautionsPrecautions Administration Instructions Administration Instructions Storage RequirementsStorage Requirements Lot Numbers and Expiration DatesLot Numbers and Expiration Dates

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Generic and Trade NamesGeneric and Trade Names

FDA recognizes the United States FDA recognizes the United States Pharmacopoeia/National Formulary Pharmacopoeia/National Formulary (USP/NF) as official registrar of all FDA (USP/NF) as official registrar of all FDA approved drugs. approved drugs.

USP/NF contains over 3700 medications USP/NF contains over 3700 medications and dietary supplements. and dietary supplements.

Generic is drug’s official name in USP.Generic is drug’s official name in USP. Brand or Trade names that have a U.S. Brand or Trade names that have a U.S.

patent and have ® example Motrin®patent and have ® example Motrin®

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National Drug CodeNational Drug Code

All drugs assigned NDC codeAll drugs assigned NDC code Helps identify the manufacture, the Helps identify the manufacture, the

product, and container size.product, and container size. Always 11 digits. Always 11 digits. Divided into 5 -4-2 Divided into 5 -4-2 Manufacture is first 5 digitsManufacture is first 5 digits Product code is 4Product code is 4 Package size is 2Package size is 2

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NDC 00006-0543-61NDC 00006-0543-61

00006 is the code for manufacture. 00006 is the code for manufacture. In this case Merck & Co, IncIn this case Merck & Co, Inc

0543 is the specific drug in this case 0543 is the specific drug in this case simvastatin generic name.simvastatin generic name.

61 is the size of the bottle, in this 61 is the size of the bottle, in this case 60 tablets.case 60 tablets.

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Storage, Lot Numbers and Storage, Lot Numbers and Expiration DatesExpiration Dates

Storage information (Room Temp, Storage information (Room Temp, Refrigeration)Refrigeration)

Lot Numbers-Important for recallsLot Numbers-Important for recalls Expiration Dates-can be affected if Expiration Dates-can be affected if

not stored properly. not stored properly.

Other things that effect Other things that effect expiration dates type of container expiration dates type of container and humidity. and humidity.

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The controlled substance The controlled substance drug scheduledrug schedule

There are 5 schedulesThere are 5 schedules Labeled with a C and roman number Labeled with a C and roman number Which schedule is determined based Which schedule is determined based

on potential for dependency and on potential for dependency and abuse.abuse.

The lower the number the higher the The lower the number the higher the potential for dependency and abuse. potential 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 HintsAssignment Hints

Show your work, so I can give partial Show your work, so I can give partial creditcredit

Turn it in early in case you need to Turn it in early in case you need to make correctionsmake corrections

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

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Metric SystemMetric System

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

scientific and industrial scientific and industrial measurementsmeasurements

Used in more than 90% of Used in more than 90% of developed countriesdeveloped countries

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Three Basic Units of Three Basic Units of MeasurementMeasurement

Weight – gram (g, gm)Weight – gram (g, gm)

Volume – liter (L)Volume – liter (L)

Length – meter (m) Length – meter (m)

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Common PrefixesCommon Prefixes

Deci- = 0.1 (one-tenth of one unit)Deci- = 0.1 (one-tenth of one unit) Centi- = 0.01 (one-hundredth of Centi- = 0.01 (one-hundredth of

one unit)one unit) Milli- = 0.001 (one-thousandth of Milli- = 0.001 (one-thousandth of

one unit)one unit) Micro- = (one-millionth of one unit)Micro- = (one-millionth of one unit) Kilo- = 1000 unitsKilo- = 1000 units

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Metric PrefixesMetric PrefixesMetric PrefixesMetric Prefixes

Figure 6-2. The basic units of measure–gram, liter, and meter–with prefixes indicating larger or smaller measures. Thus, deka- (“ten”) refers to ten basic units, and deci- (“tenth”) refers to one-tenth of the basic unit. Chart on page 131

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Sliding Mnemonic Sliding Mnemonic ConversionsConversions

KiloKilo hecto dekahecto deka METER(m)METER(m) decideci centicenti milli milli * ** * micro(µ) micro(µ)

LITER(L)LITER(L)

GRAM(g)GRAM(g)1010-3-3 1010-2-2 10 10-1-1 < <<base>><base>> 101011 10 1022 10 1033 * * 10 * * 1066

EX: EX: ..0045kg0045kg<= <= 4.5g4.5g => => 4,500mg4,500mg = = 4,500,000mcg (4,500,000mcg (µ)µ)

EX: EX: .075km.075km <= <= 75m75m => =>7500cm7500cm = =75,000mm75,000mm

Metric RulesMetric Rules

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

****If not included on assignments it If not included on assignments it will be counted as incorrectwill be counted as incorrect

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

No fractions ex: 0.1 No fractions ex: 0.1 (not 1/10)(not 1/10)

Length MeasurementLength 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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One Meter is… One Meter is…

= 1,000,000 micrometers= 1,000,000 micrometers

1 meter= 1000 millimeters1 meter= 1000 millimeters= 100 centimeters= 100 centimeters

= 10 decimeters= 10 decimeters

= 0.1 dekameters= 0.1 dekameters

= 0.01 hectometers= 0.01 hectometers

= 0.001 Kilometers= 0.001 Kilometers

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Length Conversion FactorsLength Conversion Factors

Divide if Divide if smallersmaller unit is given and larger unit is given and larger unit must be foundunit must be found

Moving decimal Moving decimal leftleft = = dividedivide

Example: Example: ________cm = ________cm = 75 mm (smaller unit)75 mm (smaller unit)

75 ÷ 10 = 7.575 ÷ 10 = 7.575 mm = 7.5 cm75 mm = 7.5 cm

Rule: 1 cm = 10 mmRule: 1 cm = 10 mm

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Length Alternate WayLength Alternate Way

75mm =75mm =________ cm cm Remember 1cm = 10mm from page Remember 1cm = 10mm from page

133133 75mm x 75mm x 1cm1cm or or 75mm x 1cm 75mm x 1cm

10mm10mm 10mm10mm mm cross each other out leaving cmmm cross each other out leaving cm 75/10= 7.5cm75/10= 7.5cm

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Length Mneumonic MethodLength Mneumonic Method

75mm=___cm75mm=___cm K h d <MLG> d c m * * µK h d <MLG> d c m * * µ Start @ milli, must move decimal to Start @ milli, must move decimal to

the left one time to reach centi so the left one time to reach centi so move 75 mm to 7.5 cmmove 75 mm to 7.5 cm

Length Conversion FactorsLength Conversion Factors

Multiply if Multiply if largerlarger unit is given and smaller unit unit is given and smaller unit must be foundmust be found

Moving decimal Moving decimal rightright = = multiplymultiply

Example: Example: ________________mmmm = 2.5 m = 2.5 m (larger unit)(larger unit)

2.5 x 1000 = 25002.5 x 1000 = 25002.5 m = 2500 mm2.5 m = 2500 mm

Rule: 1000 mm = 1 m page 133Rule: 1000 mm = 1 m page 133

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Length Alternate WayLength Alternate Way

2.5m = 2.5m = mmmm 1m = 1000mm (from page 133)1m = 1000mm (from page 133) 2.5m x 2.5m x 1000mm1000mm or or 2.5m x 1000mm2.5m x 1000mm

1m 1m1m 1m The m cross each other out leaving mmThe m cross each other out leaving mm 2.5 x 1000=2500mm2.5 x 1000=2500mm

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Length Mneumonic methodLength Mneumonic method

2.5m=____mm2.5m=____mm K h d <MLG> d c m * * µK h d <MLG> d c m * * µ Start @ meter (base) and move 3 Start @ meter (base) and move 3

decimal points to the right so 2.5m decimal points to the right so 2.5m becomes 2500mmbecomes 2500mm

Length Conversion FactorsLength Conversion Factors

Multiply if Multiply if largerlarger unit is given and smaller unit unit is given and smaller unit must be foundmust be found

Moving decimal Moving decimal rightright = = multiplymultiply

Example:Example:________________mmmm =3.6 m =3.6 m (larger unit)(larger unit)

Who can solve this?Who can solve this?

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Length Conversion FactorsLength Conversion Factors Multiply if Multiply if largerlarger unit is given and smaller unit unit is given and smaller unit

must be foundmust be found Moving decimal Moving decimal rightright = = multiplymultiply

Example:Example:________________mmmm =3.6 m =3.6 m (larger unit)(larger unit)

3.6 x 1000 = 36003.6 x 1000 = 3600

3600 mm = 3.6 m3600 mm = 3.6 m

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Length Alternate WayLength Alternate Way

3.6 m = 3.6 m = mmmm Again 1m = 1000mmAgain 1m = 1000mm 3.6m x 1000mm/1m or3.6m x 1000mm/1m or 3.6m x 1000mm3.6m x 1000mm

1m1m The m cross each other out leavingThe m cross each other out leaving 3.6 x 1000mm= 3600mm3.6 x 1000mm= 3600mm

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Length Mneumonic MethodLength Mneumonic Method

3.6m=____mm3.6m=____mm K h d <MLG> d c m * * µK h d <MLG> d c m * * µ Start @ meter (base) move 3 decimal Start @ meter (base) move 3 decimal

spaces to the right so 3.6m becomes spaces to the right so 3.6m becomes 3600mm’s3600mm’s

Liter is the metric unit of Liter is the metric unit of volumevolume

=1,000,000microliters=1,000,000microliters 1 Liter (L.) = 1,000 milliliters1 Liter (L.) = 1,000 milliliters

= 100 centiliters= 100 centiliters

=10 deciliters=10 deciliters

=0.1 dekaliter=0.1 dekaliter

=0.01 hectoliter=0.01 hectoliter

=0.001 kiloliter=0.001 kiloliter

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Volume MeasurementVolume Measurement

1 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)1L = 1000 mL=1000cc1L = 1000 mL=1000cc1L = 1qt (approx)1L = 1qt (approx)

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Metric Measure of Weight Metric Measure of Weight GramGram

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

1 gram= 1000 mg1 gram= 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 Commonly UsedMost Commonly Used

MilligramMilligram GramGram KilogramKilogram 1000mg (mg)=1 gram (g)1000mg (mg)=1 gram (g) 1000gms (g)1000gms (g) = 1 kilogram (kg. or = 1 kilogram (kg. or

kilo)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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Weight Conversion FactorsWeight Conversion Factors

_____ mg = _____ mg = 8 g(larger unit)8 g(larger unit)8 X 1000 = 8000 mg8 X 1000 = 8000 mg8000 mg = 8 g8000 mg = 8 g

Rule: 1000 mg = 1 gRule: 1000 mg = 1 g

_____ mg = _____ mg = 635 mcg (smaller unit)635 mcg (smaller unit)635 ÷ 1000 = 0.635 mg635 ÷ 1000 = 0.635 mg0.635 mg = 635 mcg 0.635 mg = 635 mcg

Rule: 1 mg = 1000 mcg or µg Rule: 1 mg = 1000 mcg or µg

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Weight Alternate WayWeight Alternate Way

_____ mg = _____ mg = 8 g8 g

Remember 1g = Remember 1g = 1000mg Page 1361000mg Page 136

8g x 1000mg/1g 8g x 1000mg/1g

oror

8g x 1000mg8g x 1000mg

1g1g

g cross each other outg cross each other out

8 x 1000= 8000mg8 x 1000= 8000mg

_____ mg = _____ mg = 635 mcg635 mcg 1mg =1000mcg Page 1mg =1000mcg Page

136136 635mcg x 635mcg x

1mg/1000mcg or1mg/1000mcg or

635mcg x 1mg635mcg x 1mg

1000mcg1000mcg mcg cross each other mcg cross each other

outout 635/1000= 0.635mcg635/1000= 0.635mcg

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Weight Mneumonic MethodWeight Mneumonic Method

8g=____mg8g=____mg K h d <MLG> d c m * * µK h d <MLG> d c m * * µ Start @ gram (base) and Start @ gram (base) and

move 3 units to the right to move 3 units to the right to get milligramsget milligrams

8g to the right becomes 8g to the right becomes 8000mg8000mg

635mcg(635mcg(µµ)=____mg)=____mg K h d <MLG> d c m * * µK h d <MLG> d c m * * µ Start @ mcg(µ) and move Start @ mcg(µ) and move

3 units to the left to reach 3 units to the left to reach milligramsmilligrams

635mcg to the left 635mcg to the left becomes 0.635mgbecomes 0.635mg

Apothecary SystemApothecary System

Old measurement system for Old measurement system for calculating drug orderscalculating drug orders

1 drop (gtt) of water = 1 minim (ɱ)1 drop (gtt) of water = 1 minim (ɱ) 60 minims(=60gtts) = 1 fluid dram 60 minims(=60gtts) = 1 fluid dram

(f(fӠӠ)) 1 grain = approximately the weight 1 grain = approximately the weight

of 1 grain of wheat or rice = 60mgof 1 grain of wheat or rice = 60mg

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Household SystemHousehold 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

Weight or massWeight 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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