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© 2010 The McGraw-Hill Companies, Inc. All rights reserved
6-1
Math and Dosage Calculations for Health
Care Third EditionBooth & Whaley
Chapter 6: Drug Labels and Package Inserts
McGraw-Hill
© 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill
6-2
6.1 Identify on a drug label the drug name, form, dosage strength, route, warnings, and manufacturing and storage information.
6.2 Locate directions on drug labels and package inserts for reconstituting and diluting medications.
Learning Outcomes
© 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill
Learning Outcomes
6.3 Recognize different types of tablets and capsules.
6.4 Distinguish administration routes for medications.
6.5 Locate additional information in a package insert.
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© 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill
Introduction
The drug label and package inserts contain information needed to perform dosage calculations.
Read the label carefully.
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Locating Information
Drug name
Form of the drug
Dosage strength
Total amount in the container
Warnings
Route of administration
Storage requirements
Manufacturing information
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© 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill
Drug Name
Generic NameOfficial name
Must appear on label
National listings United States Pharmacopeia (USP)
National Formulary (NF)
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Levothyroxine Sodium (generic name)
Levothyroxine Sodium (generic name)
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Drug Name (cont.)
Trade NameBrand nameUsed to market the drugProperty of drug company
Registered mark ® - name registered with the U.S. Patent and Trademark Office
Drug may be manufactured by more than one company.
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Synthroid (trade name)
Synthroid (trade name)
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Drug Name (cont.)
Rule 6-1 Rule 6-1 You must know both the generic and trade
names of drugs.
ExampleExample
Vicodin® is a narcotic painkiller
Generic name: hydrocodone bitartrate and acetaminophen
Other trade names: Anexsia®, Lortab®, Zydone®
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Form of the Drugs
Solid oral medicationsTablets, capsules, gelcaps, caplets
LiquidsOral, injections, inhalants, drops, sprays,
mists
OtherOintments, creams, lotions, patches,
suppositories, shampoos
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Dosage Strength
Labels include information about the amount of drug present.
The amount of drug present per dosage unit combined with information about the form identifies the drug’s dosage strength.
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Dosage Strength (cont.)
Solid medicationsDosage strength is the amount of drug
present per tablet, capsule, or other form.
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Dosage strength10 mg/1 tab
Dosage strength10 mg/1 tab
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Dosage Strength (cont.)
Liquid medicationsDosage strength is the amount of drug present
in a quantity of solution.
Amount of solution varies per dosage unit.
Pharmaceutical companies manufacture meds with dosage strengths that match commonly prescribed doses.
Reduces the risk of error when calculating dosages.
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Combination Drugs
If available, the trade name may be used to order combination drugs.
Generic names and dosage strengths of all components must appear on the label.
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Total Number or Volume in Container
Many meds are packaged in unit dosesOne tablet / section of packageVial with 2 mL of solution for injection
Multiple-dose containersPrescription medicationsNon-prescription medications
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Total Number or Volume in Container(cont.)
Rule 6-2 Rule 6-2
Do not confuse the total amount of drug in the container with the dosage strength.
The container may hold 100 tablets and each tablet has a dosage strength of 2.5 mg per tablet.
The container may hold 100 tablets and each tablet has a dosage strength of 2.5 mg per tablet.
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Route of Administration
Liquid medications• Oral • Injections
InhalantsTopical / transdermal
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Directions for route of administration may be on the label.Tablets, capsules, gelcaps, caplets
• Swallow• Sublingual• Chewable
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Error Alert!
Give the right medication by the right route.
Do not administer drugs by any route other than described in the drug label or on the order.
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Warnings
Help to administer drugs safely
Types of warningsFor specific groups, i.e. children, elderly
For controlled substances
About combining with other drugs or products
Proper disposal following facility guidelines
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Storage Information
Maintain the drug’s potency and effectiveness
Information on label Storage temperature Exposure to light Length of time drug will remain potent after
container has been opened
Improper storage can trigger a chemical reaction and make the drug unusable
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Manufacturing Information
Labels Regulated by the U.S. Food and Drug
Administration (FDA) Must include:
Name of the manufacturerExpiration dateLot number
When and where a drug was produced Trace problems
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Manufacturing Information (cont.)
Rule 6 - 3Rule 6 - 3 Never use a drug after the expiration date
has passed.
Older drugs may become chemically unstable or altered.
Incorrect doseEffect different than intended one
Educate patients to check expiration dates.
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Information About Reconstituting Drugs
Powder forms must be reconstituted and other drugs require dilution prior to use.
Directions for reconstituting or diluting are on the label.Type and amount of diluentSolution strength once reconstitutedTime period for safe administration
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Error Alert!
Consider the age and health needs of the patient when administering a drug.
If another form of a drug is better suited to a patient’s needs, consult the physician or pharmacist about changing the order.
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© 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill
Package Inserts
Complete and authoritative information about a medication
Sections
Description – chemical and physical
Clinical Pharmacology – actions of the drug
Indications and Usage
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Package Inserts (cont.)
Contraindications
Warnings – serious side effects
Precautions
Adverse Reactions – anticipated side effects
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Package Inserts (cont.)
Overdosage – effects and instruction for treatment
Dosage and Administration
Preparation for Administration
Manufacturer Supply – dosage strength and form availability
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Practice
What is the generic name of the drug?
Answer At 25°C (77°F) excursions permitted to 15-30°C (59-86°F)
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Answer 50 mg capsules
What is the dosage strength?
How should this drug be stored?
Answer celecoxib
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Oral Drugs
Solid or liquid forms
Tablets Scored – can be broken into equal portions Chewable – should be chewed to be effective Enteric-coated – must be swallowed whole Capsules
Some should be swallowed whole Others may be opened and mixed with food
Controlled-release – usually swallowed whole
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Oral Drugs (cont.)
Rule 6 - 4 Rule 6 - 4
Tablets may be broken to give a partial dose only when the tablets are scored.
Never crush or break Enteric-coated medicationsControlled-release medications (CR)Extended-release medications (ER or XL)Sustained-release medications (SR)
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Oral Drugs (cont.)
Liquids
Oral solutions
Syrups
Elixirs
Oral suspensions
Simple liquids
Dosage strength corresponds to a specific volume of the solution –
500 mg / 10 mL
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Oral Drugs (cont.)
Rule 6 - 5Rule 6 - 5
When reconstituting a drug, you must write your initials and the time and date of reconstitution on the label.
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shf 7/21/08 @ 1400
shf 7/21/08 @ 1400
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Practice
Answer Zetia®
Answer 1 tablet daily
What is the trade name of the drug?
What is the usual dosage?
What is the dosage strength?
10 mg/tablets
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Parenteral Drugs
Packaged asSingle-use ampules or vialsSingle-use prefilled syringesMulti-use vials
Small containers have small labelsDifficult to readReview package insert
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Parenteral Drugs (cont.)
RoutesIntradermally (ID)Intramuscularly (IM)Intravenously (IV)Subcutaneously (Sub-q)InhalantsTransdermal Delivery
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Parenteral Drugs (cont.)
Dosage strength is the amount of drug per dosage unitExamples
mg / tablet
mg / mL
mEq / mL
units / mL
gm / mL
gm / tablet
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Practice
Answer 20 mg/2 mL
Answer Furosemide
What is the dosage strength of the drug?
What is the drug’s name?
What is the route of administration?Answer IM or IV
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Drugs Administered by Other Routes
Sublingual (under the tongue)
Buccal (between the tongue and cheek)
Rectal
Vaginal
Topical
Eye or Ear drops
Transdermal
Inhalants
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Drugs Administered by Other Routes (cont.)
Dosage strength varies with type of drug and how it is administeredExamples
Transdermal – 0.2 mg/hr (the amount absorbed over time through the skin)
Inhalent – 84 mcg / metered spray
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Apply Your Knowledge
1. What is another name for the brand name?
2. What is the official name of a drug?
Answer trade name
Answer generic name
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Apply Your Knowledge
True or False
Enteric-coated tablets can be crushed and
mixed with food.
All capsules may be opened and mixed with food.
Parenteral forms of drugs includes transdermal and inhalants.
T
F
F
This would allow the drug to be absorbed sooner than intended.
Some capsules should be swallowed whole.
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Apply Your Knowledge
True or False (cont.)
The warnings section of a package insert lists the more serious, possibly fatal, side effects of a drug.
You may administer a drug after the expiration date has expired if you do not have any new ones.
T
F
It may not provide correct dosage strength or have an effect different than intended.
© 2010 The McGraw-Hill Companies, Inc. All rights reservedMcGraw-Hill
Apply Your Knowledge
True or False (cont.)
You can use as much solution as you need to reconstitute a powdered medication.
The amount of drug in a container is not the same as the dosage strength.
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F
You must follow the directions for reconstituting a drug that are on the label or in the package insert.
T
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End of Chapter 6
Read in order to
live.
-Henry Fielding