Classroom PoliciesWear prescribed uniform and ID all the

time.No book, no notebook, no paper, no

blue/black and red ball-pens means, NO ENTRY!

Seating arrangement must be done alphabetically

During quiz, DON’T DO ANYTHING THAT I MAY INTERPRET AS CHEATING

During group activities, make sure you participate.

If absent, please secure excuse slip or else , NO ENTRY!

Once inside, no going out until your break time.

15 minutes break only. You may bring finger-foods.

Pharmacology

Darran Earl Gowing, RN, MN

Have you wondered?

Why it’s usually okay to give children Tylenol but not aspirin? Why a lot of middle-aged and older people take an aspirin a day? Why people with high blood pressure, heart failure, or diabetes take ACE inhibitors and what ACE inhibitors are? When an antibiotic should NOT be prescribed for an infection?

Why Study Pharmacology?

A. To pass the requirement.B. You will be able to use fancy terms

like “Pharmacodynamics”.C. My instructor likes to torture people.D. A competent nurse must understand

why his/her patient is getting a medication, and HOW IT WORKS.

PurposeThe purpose of studying PHARMACOLOGY is to help you learn about medicines and the WHY, WHAT, HOW, WHEN, and WHERE they are used in daily life.

Origin of Drugs

BEFORE…Drugs were mainly derived from

Plants (eg, morphine)animals (eg, insulin)and minerals (eg, iron)

ORIGIN2700 BB – earliest

recorded drug use found in Middle East & China

1550 BC – Egyptians created Ebers Medical Papyrus

ORIGINGalen (131-201 AD) Roman

physician; initiated common use of prescriptions

1240 AD – introduction of apothecary system (Arab doctors)

1st set of drug standards & measurements (grains, drams, minims), currently being phased out

ORIGIN15th century –

apothecary shops owned by barber, surgeons, physicians, independent merchants

18th century – small pox vaccine (by Jenner)Digitalis from foxglove plant for strengthening & slowing of heartbeat Vitamin C from fruits

ORIGIN19th century – morphine &

codeine extract from opiumIntroduction of atropine & iodineAmyl nitrite used to relieve anginal painDiscovery of anesthetics (ether, nitrous oxide)

Early 20th century – aspirin from salicylic acidIntroduction of Phenobarbital, insulin, sulforamides

ORIGINMid 20th century1940 – Discovery

antibiotics (penicilline, tetracycline,

streptomycin), antihistamines, cortisone

1950 – discovery antipsychotic drug, antihypertensives, oral contraceptives, polio vaccine

Dr Albert Sabin, b. 1906, developer of the oral live polio vaccine.

NOW…SyntheticSemi-syntheticBiotechnology

Knowing the terms!

Pharmacology pharmacon - meaning druglogos - meaning scienceis the study of drugs (chemicals) that alter functions of living organisms.

Drug therapyalso called pharmacotherapy, is the use of drugs to prevent, diagnose, or treat signs, symptoms, and disease processes.

Medication Drugs given for therapeutic purposes.

Pharmacoeconomics involves the costs of drug therapy, including those of purchasing, dispensing, storage, administration, laboratory and other tests used to monitor client responses, and losses from expiration.

DrugAny chemical that affects the physiologic processes of a living organism

DrugsChemical name• Describes the drug’s chemical

composition and molecular structureGeneric name (non-proprietary

name)• Name given by the country or

Adopted Name Council

Trade name (proprietary name)• The drug has a registered trademark;

use of the name restricted by the drug’s patent owner (usually the manufacturer)

DrugsChemical name• (+/-)-2-(p-

isobutylphenyl) propionic acid

Generic name• Ibuprofen

Trade name• Alaxan®, Advil®

Classification• Classification:–Functional Class vs. Chemical Class

• Medication classification indicates:– effect of the medicine– symptom the medicine relieves– medicine desired effect (e.g. oral hypoglycemics)

Classification

A medication may also be part of more than one class Aspirin is an analgesic, antipyretic, anti-inflammatory, and anti-platelet

Medication FormsMedications are available in a variety of forms and preparationsThe form of the med will determine its route of administrationComposition of med is designed to enhance its absorption & metabolism

Medication FormsTabletCapsuleCapletElixirEnteric-coatedSuppositorySuspension

Transdermal patchDropsInjectionsOintmentTinctureLinimentAerosol

Tablets

Capsule

Caplet

ENTERIC COATED

Suspension

Subcutaneous Injection

Intramuscular or IM

Ointment

Elixir

Patch

Eye Drops or Eye Ointment

Ear Drops

Tincture

Aerosol

Suppositories

Pharmacologic Principles

PhasesPharmaceuticsPharmacokineticsPharmacodynamicsPharmacotherapeuticsPharmacognosy

Drug available for action

Dose of Formulated Drug

Disintegration of dosage from dissolution of drug

Absorption, distribution,metabolism, excretion

Administration

Drug-receptorinteraction

Drug available for absorption

EFFECT

PHARMACEUTICAL PHASE

PHARMACOKINETIC PHASE

PHARMACODYNAMIC PHASE

PHASES OF DRUG ACTIVITY(source: Mosby’s Pharmacology for Nursing (2003))

PharmaceuticsThe study of how various drug forms influence pharmacokinetic and pharmacodynamic activities

Figure 2-1 The chemical, generic, and trade names for the common analgesic ibuprofen are listed next to the chemical structure of the drug.

Drug Transport

What does this have to do with drug administration?Drugs must reach and interact with or cross the cell membrane to stimulate or inhibit cellular function

PharmacokineticsThe study of what the body does to the drug–Absorption–Distribution–Metabolism–Excretion

Remember: ”ADME”

Pharmacokinetics

Pharmacokinetics: Absorption

The rate at which a drug leaves its site of administration, and the extent to which absorption occurs–Bioavailability–Bioequivalent

Factors That Affect Absorption

• Administration route of the drug• Ability of Medicine to Dissolve• Food or fluids administered with the drug• Body Surface Area• Status of the absorptive surface• Rate of blood flow to the small intestine• Lipid Solubility of Medicine• Status of GI motility

Factors Affecting Pharmacokinetics

AgeDiseasesIndividual DifferencesPsychological FactorsType & Amount of Drug PrescribedSocial Factors

Routes

Oral

Pills, capsules, tablets, liquidsSL, Buccal, NG, Gastrostomy, Duodenostomy tubes

NOTE:Assess client’s ability to take oral medications

Oral Drugs

Dosage is determined by how much of the drug is required to be taken by mouth to given the desired affect.Time in the stomach – is the stomach empty – full – does it make a difference on how drug is absorbedSmall intestine – large surface area for absorption of nutrients and minerals

What else might influence oral drug absorption?

Food in stomachCertain juices – grapefruit juice Milk – binds with molecules of some drugs so that the drug is never absorbedOrange juice – enhances absorption of iron taken orallyThe coating on the tablet: chewable, enteric coated (breakdown occurs in small intestine), slow release capsules

Intradermal Sites

Ventral forearmUpper chestShoulder

Subcutaneous Sites

Outer aspects of the arms & thighsHip & lower abdomenAbove the iliac crest

Intramuscular

Ventrogluteal for 1 year and above

Intramuscular

Vastus lateralis

below 1 year old

Intramuscular

Dorsogluteal - clients w/ well-developed gluteal muscles

Intramuscular

Deltoid

Intravenous

(IV) is the installation of fluid and/or electrolytes, or nutrient, medication substances into a vein.

Topical Agent

skin, ophthalmic, otic, nasal, vaginal, rectal

Inhalation

Distribution

Transportation of drug molecules within the bodyDrug needs to be carried to the site of the action

Need blood to circulate the drugHeart, liver, kidneys

Key Concepts of Distribution

Protein binding – drug molecules need to get from the blood plasma into the cellProtein binding allows part of the drug to be stored and released as neededSome of the drug is stored in muscle, fat and other body tissues and is gradually released into the plasma

Just how does the drug get into the cell?

Drug must pass though the capillary wallBlood brain barrier – very effective in keeping drugs from getting into the central nervous system or CNS – limits movement of drug molecules into brain tissue

Blood Brain Barrier

This is especially important when treating infections of the brain such as meningitis, encephalitis, or brain abscessMedications must be able to penetrate the blood brain barrierMedications usually given intravenous

Three ways to get in!• Direct penetration of the membrane• Protein channels• Carrier proteins

# 1 Lipid Soluble Drugs• Lipid soluble drugs are able to dissolve in

the lipid layer of the cell membrane• No energy expended by the cell• Passive diffusion– Oral tablets or capsules must be water

soluble to dissolve in fluids of the stomach and small intestine

# 2 Protein Channels

Most drug molecules are to big to pass in to the cell via the channels – small ions such as sodium and potassium use the protein channels but their movement is regulated by gating mechanisms – only small amounts allowed

# 3 Carrier Proteins

Molecule needs to bind with a protein that will transport it from one side of the cell membrane to another – a drugs structure determines which carrier will transfer it.

Metabolism• Method by which the drugs are inactivated

or biotransformed by the body– Active drugs contain metabolites that

are excreted – skin, urine, stool• Most drugs metabolized in the liver by

cytochrome P450 (CYP)

What can stop this process?

• Enzyme inhibition– Other drugs– Combination drugs– Liver disease – Impaired blood circulation in person with

heart disease– Infant with immature livers–Malnourished people or those on low-

protein diets

An important concept!• First-pass effect – some drugs are

extensively metabolized or broken down in the liver and only a part of the drug is released into the systemic circulation

• This is why dosage is important – how much drug needs to be taken in to give the desired effect and how often does it need to be taken

Excretion

Refers to the elimination of the drug from the bodyRequires adequate functioning of the circulatory system and organs of excretion

KidneysBowelsLungsSkin

You are caring for a client who has diabetes complicated by kidney disease. You will need to make a detailed assessment when administering medications because this client may experience problems with:

A. AbsorptionB. BiotransformationC. DistributionD. Excretion

Laboratory Values• Laboratory values reflecting function of

liver and kidneys need to be looked at. – BUN and Creatinine – kidney function– Liver function tests:• ALT – alamine aminotransferase

(elevated in hepatitis)• AST or SGOT– aspartate

aminotransferase – elevated in liver disease • Bilirubin levels – infants – gallstones in

adults

Serum Drug Levels• Laboratory measurement of the amount of

drug in the blood at a particular time• A minimum effective concentration (MEC)

must be present before a drug exerts its action on a cell.

Toxic Levels• Excessive level of a drug in the body– Single large dose– Repeated small doses– Slow metabolism which allows drug to

accumulate in the body– Slow excretion from the body by the

kidneys or gastrointestinal tract

Laboratory values are important!

• Serum drug levels indicate the onset, peak and duration of the drug action

Do we do serum drug levels for all drugs?

• No • When do we need them?– Drugs with narrow margin of safety

(digoxin, aminoglycoside antibiotics, lithium)

– To check to see if the drug is at therapeutic levels – seizure medications

–When drug overdose is suspected

Important concept!• Serum half-life or elimination half-life is the

time it takes the serum concentration of the drug to reach 50%– A drug with a short half-life requires

more frequent administration– A drug with a long half-life requires less

frequent administration

Why is this important?• Half-life determines how often a drug is

given– Daily in the morning– At bedtime– Q.I.D - four times a day– T.I.D – three times a day– Q4 hours – every four hours– Q 12 hours – 9 am and 9 pm

Pharmacodynamics• The study of

what the drug does to the body the mechanism of drug actions in living tissues

“WHAT THE DRUG DOES TO THE BODY”

Cellular Physiology

What does a cell do?Exchange materialObtain energy from nutrientsSynthesize hormones, neurotransmitters, enzymes, structural proteins and other complex moleculesDuplicate themselves

Pharmacodynamics

Drugs can:1.Inhibit2.Activate3.Replace

Enzyme Interaction• Enzymes are substances that catalyze

nearly every biochemical reaction in a cell• Drugs can interact with enzyme systems

to alter a response• Inhibits action of enzymes-enzyme is

“fooled” into binding to drug instead of target cell

• Protects target cell from enzyme’s action (ACE Inhibitors)

Receptor theory

Most drugs exert their effects by chemically biding with receptors at the cellular level.Receptors are proteins located

on the surfaces of cell membranes within the cells

What do the RECEPTORS do?

The receptors are often described as the lock into which the drug molecule fits as a key.All body cells do not respond to all drugs even when all the cells are exposed to the drug.

RECEPTOR

LOCKS KEYS

PharmacodynamicsReceptors are

regulated in TWO WAYS:

1.Agonists (activators) – bind to the receptor and act to produce a pharmacologic effect

2.Antagonists (blockers) – bind to the receptor and prevent the cell from producing an effect

Agonist-Antagonist

More is not better!

Number of receptors site available will effect drug action so giving a higher dose does not necessarily produce additional pharmacological effects.

Drug Dosing

Often the first dose is higher in an effort to bring the therapeutic blood serum levels up quicker

Drug – Diet interaction

Food can slow absorptionFood substances can react with certain drugsHow to give medication is information provided in you drug manual

Drug – Drug Interaction• Some drugs taken together will enhance

each other – Tylenol with codeine

• Some drugs taken together will interfere with another drugs actions

• Some drugs are given to decrease or reverse the toxic effects of a drug– Narcotic antidote is naloxone

Drug Tolerance

Body becomes accustomed to drug over period of time

Adverse Effects• Undesired response• Allergic reaction• Drowsiness• Nausea / vomiting / GI upset• Liver or kidney damage• Fevers• Drug dependency• Cancinogenicity – ability to cause cancer• Teratogenicity – cause damage to fetus

Pharmacotherapeutics

The use of drugs and the clinical indications for drugs to prevent and treat diseases

MonitoringThe effectiveness of the drug therapy must be evaluated.One must be familiar with the drug’s intended therapeutic action (beneficial) and the drug’s unintended but potential side effects (predictable, adverse drug reactions).

Types of Therapies

Acute therapyMaintenance therapySupplemental therapyPalliative therapySupportive therapyProphylactic therapy

Type of Medication Action

Therapeutic EffectSide EffectsAdverse EffectsToxic EffectIdiosyncratic ReactionsAllergic ReactionMedication InteractionsIatrogenic Response

Therapeutic Effect

The expected or predictable physiological response a medication causesA single med can have several therapeutic effects

Side Effects

‘A drug that does not

cause side-effects is a drug that does not work.’

Unintended secondary effects a medication predictably will causeMay be harmless or seriousIf side effects are serious enough to negate the beneficial effect of meds therapeutic action, it may be D/CPeople may stop taking medications because of the side effects

ADVERSE RECTION

• Medication misadventures–Adverse drug events–Adverse drug reactions –Medication errors

Adverse Effects

Undesirable response of a medicationUnexpected effects of drug not related to therapeutic effectMust be reported to FDACan be a side effect or a harmful effectCan be categorized as pharmacologic, idiosyncratic, hypersensitivity, or drug interaction

Toxic effect

ToxicologyThe study of poisons and unwanted responses to therapeutic agents

Toxic Effect

May develop after prolonged intake or when a medicine accumulates in the blood because of impaired metabolism or excretion, or excessive amount takenToxic levels of opioids can cause respiratory depressionAntidotes available to reverse effects

Table 2-9 Common Poisons and Antidotes

Idiosyncratic Reactions

Unpredictable effects-overreacts or under reacts to a medication or has a reaction different from normalNormal effect is produce by a small fraction of the standard dose.

Allergic Reaction

Unpredictable response to a medicationMakes up greater than 10% of all medication reactionsClient may become sensitized immunologically to the initial dose, repeated administration causes an allergic response to the medicine, chemical preservative or a metabolite

Allergic Reaction

Medication acts as an antigen triggering the release of the body’s antibodiesMay be mild or severe

A postoperative client is receiving morphine sulfate via a PCA. The nurse assesses that the client’s respirations are depressed. The effects of the morphine sulfate can be classified as:

A. AllergicB. IdiosyncraticC. TherapeuticD. Toxic 35 - 114

Other Drug Reactions

Teratogenic-Structural effect in unborn fetusCarcinogenic-Causes cancerMutagenic- Changes genetic composition (radiation, chemicals)

Iatrogenic ResponsesUnintentional adverse effects that occur during therapyTreatment Induced Dermatologic

rash, hives, acneRenal Damage

Aminoglycoside antibiotics, NSAIDS, contrast medium

Blood DyscrasiasDestruction of blood cells (Chemotherapy)

Hepatic ToxicityElevated liver enzymes

DRUG INTERACTIONS

InteractionsAdditive effectSynergistic effectAntagonistic effectIncompatibility

ADDITIVE EFFECT

Drugs are said to have an additive effect when they have similar actions. Lower doses are needed when the drugs are given together.Similar therapeutic activity can cause problems if administered together

Synergistic Effect

Effect of 2 meds combined is greater than the meds given separatelyAlcohol & Antihistamines, antidepressants, barbiturates, narcotics

ANTAGONIST EFFECT

Combined effect is less than each of them alone.Drugs with opposite action to that of another drug or natural body chemicalExamples: Beta-blockers the ‘olol’ drugs

INCOMPATIBILITY EFFECT

Drugs are incompatible when combining them causes chemical deterioration of one or both

NURSING RESPONSIBILITY

The Nursing Process

Assessment

Diagnosis

PlanningImplementation

Evaluation

Assessment

Diagnosis

PlanningImplementation

Evaluation

The Nursing Process

Assessment• Data collection – Subjective, objective– Data collected on the patient, drug,

environment

• Medication history• Nursing assessment• Physical assessment• Data analysis

Constant System Analysis

• A “double-check”• The entire “system”

of medication administration

• Ordering, dispensing, preparing, administering, documenting

• Involves the physician, nurse, nursing unit, pharmacy department, and patient education

Administering Medications

1. Right Patient 2. Right Medication 3. Right Dosage 4. Right Route 5. Right Time 6. Right Documentation7. Right Client Education 8. Right to Refuse 9. Right Assessment 10. Right Evaluation 

Other “Rights”

Proper drug storageCareful checking of transcription of ordersPatient safetyClose consideration of special situationsPrevention and reporting of medication errorsMonitoring for therapeutic effects, side effects, toxic effects

Evaluation

Ongoing part of the nursing processDetermining the status of the goals and outcomes of careMonitoring the patient’s response to drug therapy

Assessment

Diagnosis

PlanningImplementation

Evaluation

Questions???The day shift charge nurse is making rounds. A patient tells the nurse that the night shift nurse never gave him his medication, which was due at 11 PM. What should the nurse do first to determine whether the medication was given?

1.Call the night nurse at home.2.Check the Medication sheet.3.Call the pharmacy.4.Review the nurse’s notes.

Questions???The patient’s Medication sheet lists two antiepileptic medications that are due at 0900, but the patient is NPO for a barium study. The nurse’s coworker suggests giving the medications via IV because the patient is NPO. What should the nurse do?

1.Give the medications PO with a small sip of water.

2.Give the medications via the IV route because the patient is NPO.

3.Hold the medications until after the test is completed.

4.Call the physician to clarify the instructions.

Know your drug• Clients expect you to be knowledgeable• You gain this knowledge be looking up

medications– Drug hand book– PDA– Pharmacist

Legal Responsibilities• The nurse is responsible for–safe and accurate administration–having sufficient drug knowledge

to recognize and question erroneous orders–actions delegated to other persons

– orderly cannot give medications–monitor clients response to a

medication– following safe practices – the ten

rights

Medication Systems

Each facility has a system for administering medicationBe familiar with this process & need to learn at each new facilityBasics of medication administration guidelines should always be observed

Medication Orders• Full name of client• Generic or trade name of drug• Dose, route, frequency • Date, time and signature of provider• The nurse will need to look up the

medication ordered to know it’s classification, safe dose, action, how to administer, and side effects

• The nurse should know why the medication is ordered

LIFE SPAN CONSIDERATIONS

Life Span Considerations

• Pregnancy• Breast-feeding• Neonatal• Pediatric• Geriatric

Pregnancy

First trimester is the period of greatest danger for drug-induced developmental defectsDrugs diffuse across the placentaFDA pregnancy safety categories

PREGNANCY CLASSIFICATION

Class AStudies failed to demonstrate fetal anomalies.

Class BAnimal studies have not demonstrated a fetal risk.Information in human is not available

PREGNANCY CLASSIFICATION

Class CStudies in animal have revealed an adverse effect

Class DThere is a positive evidence of fetal risk but in some cases may warrant the use of these drugs

Class XStudies in animal and human have revealed abnormalities

Breast-feeding

• Breast-fed infants are at risk for exposure to drugs consumed by the mother

• Consider risk-to-benefit ratio

Table 3-2 Classification of young patients

Pediatric Considerations: Pharmacokinetics

• Absorption– Gastric pH less acidic– Gastric emptying is

slowed– Topical absorption

faster through the skin

– Intramuscular absorption faster and irregular

Pediatric Considerations

• Distribution– TBW 70% to 80% in

full-term infants, 85% in premature newborns, 64% in children 1 to 12 years of age

– Greater TBW means fat content is lower

– Decreased level of protein binding

– Immature blood-brain barrier

Pediatric Considerations

• Metabolism–Liver immature,

does not produce enough microsomal enzymes–Older children

may have increased metabolism, requiring higher doses–Other factors

Pediatric Consideration

• Excretion– Kidney immaturity

affects glomerular filtration rate and tubular secretion

– Decreased perfusion rate of the kidneys

Summary of Pediatric Considerations

Skin is thin and permeableStomach lacks acid to kill bacteriaLungs lack mucus barriersBody temperatures poorly regulated and dehydration occurs easilyLiver and kidneys are immature, impairing drug metabolism and excretion

Methods of Dosage Calculation for Pediatric Patients

• Body weight dosage calculations

• Body surface area method

Geriatric Considerations

Geriatric: older than age 65Healthy People 2010: older than age 55

Use of OTC medicationsPolypharmacy

Geriatric Considerations: Pharmacokinetics

• Absorption– Gastric pH less acidic– Slowed gastric

emptying–Movement through

GI tract slower– Reduced blood flow

to the GI tract– Reduced absorptive

surface area due to flattened intestinal villi

Geriatric Considerations

• Distribution– TBW percentages

lower– Fat content increased– Decreased

production of proteins by the liver, resulting in decreased protein binding of drugs

Geriatric Considerations

• Metabolism–Aging liver

produces less microsomal enzymes, affecting drug metabolism–Reduced blood

flow to the liver

Geriatric Considerations

• Excretion–Decreased

glomerular filtration rate–Decreased

number of intact nephrons

Geriatric Considerations

• Analgesics• Anticoagulants• Anticholinergics• Antihypertensives• Digoxin• Sedatives and

hypnotics• Thiazide diuretics

MEDICATION ERRORS:PREVENTING & RESPONDING

Medication Misadventures

• By definition, all ADRs are also ADEs

• But all ADEs are not ADRs

• Two types of ADRs– Allergic reactions– Idiosyncratic reactions

Medication Errors

• Preventable• Common cause of

adverse health care outcomes

• Effects can range from no significant effect to directly causing disability or death

Common classes of medications involved in serious errors

Preventing Medication Errors

Minimize verbal or telephone orders

Repeat order to prescriberSpell drug name aloudSpeak slowly and clearly

List indication next to each orderAvoid medical shorthand, including abbreviations and acronyms

Preventing Medication

Never assume anything about items not specified in a drug order (i.e., route)Do not hesitate to question a medication order for any reason when in doubtDo not try to decipher illegibly written orders; contact prescriber for clarification

Preventing Medication

NEVER use “trailing zeros” with medication ordersDo not use 1.0 mg; use 1 mg1.0 mg could be misread as 10 mg, resulting in a tenfold dose increase

ALWAYS use a “leading zero” for decimal dosagesDo not use .25 mg; use 0.25 mg.25 mg may be misread as 25 mg “.25” is sometimes called a “naked decimal”

Preventing Medication

• Check medication order and what is available while using the “10 rights”

• Take time to learn special administration techniques of certain dosage forms

Preventing Medication Errors (cont'd)

Always listen to and honor any concerns expressed by patients regarding medications

Check patient allergies and identification

Nurses are legally required to document medications that are administered to clients. The nurse is mandated to document:

A. Medication before administering it

B. Medication after administering it

C. Rationale for administering the medication

D. Prescriber’s rationale for prescribing the medication

35 - 166

If a nurse experiences a problem reading a physician’s medication order, the most appropriate action will be to:

A. Call the physician to verify the order.

B. Call the pharmacist to verify the order.

C. Consult with other nursing staff to verify the order.

D. Withhold the medication until the physician makes rounds.

35 - 167

METRIC SYSTEM

Metric System

• Meter is used for linear measure, gram for weight and liter for volume

Apothecary System

Grains, minims, drams, ounces, pounds, pints, and quarts

Household measures

Drops, teaspoons, tablespoons and cupsImportant since this is often how people take medications

Units

mEq – drugs ordered in number of units per dose

Insulinheparin

Milliliters

mL = milliliter. This is a VOLUME measurement. it is 1/1000 of a liter. when talking about water or similar liquids, it is equivalent to one cubic centimeter.

Cubic Centimeter

cc = cubic centimeter. This is also a VOLUME measurement. Most syringes measure their capacity in cc's. If you have a 5cc syringe, it will hold ~5mL of liquid in it.

mL and cc’s• 1 mL = 1cc • 1 cc = 15 to 16 minims• 1 cc = 15 to 16 drops

• Fluids are generally written in cc’s to standardize the abbreviation – you may see mL’s written but this abbreviation is being eliminated

cc’s and household measures

• 5 cc = 1 tsp (teaspoon)• 15 cc = 1 tbs (tablespoon)• 30 cc = 1 oz (ounce) = 2

tablespoons• 240 cc = 8 oz or 1 cup

Milligrams• mg = milligram. This is a WEIGHT

measurement. It is 1/1000 of a gram. the amount of chemical substance is often measured in milligrams. For injectable solutions, this will be reported as a concentration of weight to volume, such as mg/ml (milligrams per milliliter).

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