Pharma ppt

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nursing pharmacology

Text of Pharma ppt

DOSAGE CALCULATION

1

Levi Adriano Santana, RN

Academic Instructor BSU College Of NursingBSU College of Science

Chief NurseApalit Doctors Hospital Inc

Certified BLS/ ACLS ProviderPhilippine Heart Association/ Philippine College of Cardiology

Emergency and Disaster ResponderMMDA Public Safety Division

NURSING PHARMACOLOGYDosagesWays to calculate dosage:Formula Method

Amount to GiveChallenge: Must remember the extra step of changing D and H to same unit of measurement. Also may have extra variables such as body weight, times per day, etc. 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillWays to calculate dosage:Ratio and ProportionLinear Ratio and Proportion

Fractional Ratio and Proportion

500mg : 1 tab :: 1 g : x tabsProduct of the means equals the product of the extremes.

The products of cross multiplication in a proportion are always equal

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillNecessities for Student Success in Dosage CalculationsReview of basic math functions fractions and decimalsAddingSubtractingMultiplicationDivisionStudents must memorize equivalents

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillThe 4 main questionsWhat is the order?What is on hand?Do you need any equivalents?Where are you going? (or what are you being asked to give?) 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillStart with conversions

240 mg = ______ grains

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillStart with conversions

240 mg = ______ grains

grains144 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillOrder: Lasix 40 mg PO dailyDose on Hand: 80 mg/10 mlWhat is the order?

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillOrder: Lasix 40 mg PO dailyDose on Hand: 80 mg/10 mlWhat is on hand?

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillOrder: Lasix 40 mg PO dailyDose on Hand: 80 mg/10 mlDo you need any equivalents?

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillOrder: Lasix 40 mg PO dailyDose on Hand: 80 mg/10 mlWhere are you going? (or what are you being asked to give?)

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillOrder: Lasix 40 mg PO dailyDose on Hand: 80 mg/10 mlBegin by cross canceling labels

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillOrder: Lasix 40 mg PO dailyDose on Hand: 80 mg/10 mlLabels left should be what you are looking for

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillOrder: Lasix 40 mg PO dailyDose on Hand: 80 mg/10 mlDo the math

12551 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillWhat about problems with different units of measurement?Order: digoxin elixir 0.05 mg PO dailyLabel: Digoxin 50 mcg per mlHow many milliliters will you give?

ml1201 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillComplex Problems

Order: Augmentin 12.5mg/kg PO every 12 hours. Child weighs 22 lbs. Pharmacy sends a 75 ml bottle of Augmentin labeled 125mg/5ml. How many milliliters will you pour from the bottle?

ml

5 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillWhat about IV problems?Order: 250ml 5% D/W IV in 2.5 hours.Tubing package reads 15 gtts/ml.How many gtts/min will you adjust the IV?

25 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillPhysicians order Daypro 1200 mg bid.

12cap2 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillOrder: Estratab 1250mcg daily

tab

1 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillPractice Problems

2010 The McGraw-Hill Companies, Inc. All rights reserved 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillYour patient may receive Dilaudid 3 mg IM q3h for pain. Dilaudid is supplied in 1-ml ampules containing 4 mg. How many milliliters will you administer?

ml= 0.75 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillThe physician orders heparin 2500U subq. You have heparin, 5000U per ml. How many ml will you administer?

ml12

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillYour patient needs morphine gr 1/6 SQ stat for chest pain. You have a 20 ml vial labeled 15mg/ml. How many milliliters will you give?

ml

0.67 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-HillA patient with tachycardia has an order for Brevibloc to be started at 50 mcg/kg/min. The concentration is Brevibloc 5 g in 500ml of D5W. The patient weighs 176 pounds. How many ml/h should the IV pump be programmed for?

ml/hr

12125140180121122424

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill24 25ReconstitutionReconstitution problems ask the nurse to dissolve a drug (typically a powder) whose quantity is usually expressed in grams or milligrams in: a specific quantity of a liquid (usually measured in milliliters). Frequently, the liquid is normal saline (0.9% NS) or D5W.Conceptually, this is identical to dissolving 1 teaspoon of table salt in 1 cup of hot water. 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill26ReconstitutionOrder: 350 mg of the drug to be given q8h IV. How many mL will you give per dose?

Supply: The drug is available in 500 mg containers. The label tells the nurse to dissolve the powder in 25 mL of normal saline (NS).

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill27ReconstitutionWhich pairs of data do you find in the problem?350 mg every 8 hours. (every 8 hours means: 1 dose.)500 mg of the powder is dissolved in 25 mL of NS.

What is the answers label for your calculation?How many mL/dose?

Can you isolate all of the components that are required to solve this problem? (YES, of course you can do this!)

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill28Answer Reconstitution mL/dose = (25 mL/500 mg) * (350 mg/dose) = 17.5 mL/dose

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill29Reconstitution Order: 250 mg of the drug to be given q8h IV. How many mL will you give per dose?

Supply: The drug is available in 1g containers. The label tells the nurse to dissolve the powder in 50 mL of normal saline (NS). 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill30Answer Reconstitution mL/dose = (50 mL/1 g) * (1 g/1000 mg) * (250 mg/dose) = 12.5 mL/dose 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill31Reconstitution Order: 20 mg/Kg of the drug to be given q8h IV. Patient weighs 50 pounds. How many mL will you give per dose?

Supply: The drug is available in 500 mg containers. The label tells the nurse to dissolve the powder in 5 mL of normal saline (NS). With which data pair is the dose a factor? Why?

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill32Answer Reconstitution mL/dose = (5 mL/500 mg) * (20 mg/1 Kg/1 dose) * (1 Kg/2.2 lbs) * (50 lbs/1) = 4.545 rounds up to 4.55 mL/dose

Dose is only related mg/Kg. 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill33Reconstitution Graphic 5 million Units in 3.2 mL1 million Units/1 mLThe patientWhich medication source DIRECTLY affects the patient? 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill10-34Intravenous (IV) fluidsDelivered directly into the bloodstream via a vein

IncludesSolutionsMedications Blood

Rapid effect Results can be fatal if wrong medication or dosage is given.

IV Solutions 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill3410-35IV Solutions FUNCTIONSReplacementElectrolytes Fluids

Maintenance Fluid balanceElectrolyte balanceKVO fluidsKeep Vein OpenMaintain an IV line

Therapeutic Delivers medication to patient

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill10-36IV Solutions IV LABELSSolution labelsName of components

The exact amount of components

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill10-37IV Solutions IV LABELS (cont.)Rule 10-1 In abbreviations for IV solutions:

Letters identify components

Numbers identify concentration

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill10-38IV Solutions IV LABELS (cont.)5% dextrose in Lactated Ringers solution might be abbreviated in any of the following ways:D5LRD5LR5% D/LR D5%LRExample

2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill10-39IV Solutions COMMONLY USED ABBREVIATIONSABBREVIATIONSOLUTIOND10W10% dextrose in waterD5W5% dextrose in waterW; H2OWaterNS; NSSNormal saline (0.9% NaCl)LRLactated ringersRLRingers lactate 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill3910-40IV Solutions COMMONLY USED ABBREVIATIONS (cont.)ABBREVIATIONSOLUTION NS; NSSOne-half normal saline solution (0.45% NaCl)1/3 NS; 1/3 NSSOne-third normal saline solution (0.3% NaCl) NS; NSSOne-fourth normal saline solution (0.225% NaCl) 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill4010-41

IV Solutions IV CONCENTRATIONS5% Dextrose contains 5 g of dextrose per 100 mL

Normal saline 0.9% salineContains 900 mg, or 0.9 g, of sodium chloride per 100 mL.

Normal saline0.45% salineContains 450 mg, or 0.45 g, of sodium chloride per 100 mL 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill10-42

IV Solution