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161 Cards in this Set
- Front
- Back
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Definition of Pharmacology
Definition of Metrology |
Pharmacology = study of the nature, chemistry, effects, and uses of drugs
- Clinical pharmacology is the study of drugs in humans. Metrology = the science of measurements; measuring and calculating drugs accurately |
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Abbreviations - a
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before
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Abbreviations - aa
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of each
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Abbreviations - ac
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before meals
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Abbreviations - pc
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after meals
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Abbreviations - bid
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twice a day
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Abbreviations - tid
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three times a day
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Abbreviations - qid
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four times a day
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Abbreviations - qh
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every hour
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Abbreviations - qn
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every night
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Abbreviations - stat
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at once
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Abbreviations - q2h
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every 2 hours
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Abbreviations - q4h
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every 4 hours
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Abbreviations - q6h
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every 6 hours
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Abbreviations - prn
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as needed
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Abbreviations - biw
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twice a week
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Abbreviations - qd (no longer accepted)
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daily
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Abbreviations - qod (no longer accepted)
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every other day
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Abbreviations - tiw (no longer accepted)
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three times a week
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Abbreviations - qhs (no longer accepted)
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hour of sleep, nightly at bedtime
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Abbreviations - HS (no longer accepted)
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half-strength
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Abbreviations - PO
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by mouth
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Abbreviations - IM
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intramuscular
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Abbreviations - IV
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intravenous
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Abbreviations - IVP
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intravenous push
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Abbreviations - IVPB
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intravenous piggyback
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Abbreviations - MDI
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metered dose inhaler
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Abbreviations - NG or NGT
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nasogastric tube
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Abbreviations - PR
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per rectum
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Abbreviations - SL
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sublingual
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Abbreviations - S&S
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swish and swallow
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Abbreviations - AD (no longer accepted)
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right ear
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Abbreviations - AS (no longer accepted)
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left ear
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Abbreviations - AU (no longer accepted)
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both ears
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Abbreviations - OD (no longer accepted)
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right eye
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Abbreviations - OS (no longer accepted)
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left eye
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Abbreviations - OU (no longer accepted)
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both eyes
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Abbreviations - SC or SQ (no longer accepted)
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subcutaneously or sub-Q or Sub Q
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Metric Abbreviations - g (gm, Gm)
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gram
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Metric Abbreviations - mg
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milligram (1000 mg = 1 gram, 60 mg = 1 gr approx)
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Metric Abbreviations - kg (Kg)
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Kilogram (1 kg = 2.2 lbs)
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Metric Abbreviations - mcg
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microgram (1000 mcg = 1 mg)
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Metric Abbreviations - mEq
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milliequivalent
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Metric Abbreviations - mL
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milliliter (equal to 1 cc)
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Metric Abbreviations - L
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liter (little more than a quart)
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Metric Abbreviations - cc (no longer accepted)
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cubic centimeter. Use mL
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Metric Abbreviations - U or IU (no longer accepted)
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unit (a measure of a drug in terms of action, not physical weight). International Unit (IU mistaken for IV).
Heparin and insulin are measured in units. 1-2 units of insulin will lower blood sugar by 30-50 mg/dl mcg or microgram. |
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Metric Abbreviations - MS, MSO4, MGSO4 (no longer accepted)
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mistaken for each other (morphine and magnesium sulfate)
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Metric Abbreviations - < and > (no longer accepted)
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mistaken for opposite, write out "greater than," or "less than"
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Metric Abbreviations - ss (no longer accepted)
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write out "one half" or write 1/2
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Common Apothecary Abbreviations - m, mx (don't use)
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minim (equal to one drop; 15 or 16 cm = 1 mL)
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Common Apothecary Abbreviations - dr (problematic)
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dram (one dram = 4 mL)
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Common Apothecary Abbreviations - 8 drams (problematic)
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one ounce approx
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Common Apothecary Abbreviations - gtt (problematic)
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one drop (1 gtt = 1 minim)
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Common Apothecary Abbreviations - gr (problematic)
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grain (1 grain = 60-65 mg)
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Common household abbreviations - pt
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pint (approx 500 mL)
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Common household abbreviations - qt
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quart (approx 01 L)
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Common household abbreviations - tbsp
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tablespoon (15 mL)
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Common household abbreviations - tsp
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teaspoon (5 mL)
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Common household abbreviations - oz
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30 mL
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Common household abbreviations - cup
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240 mL or 8 ounces
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Abbreviations - cap
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capsule
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Abbreviations - CR
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controlled release
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Abbreviations - LA
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long acting
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Abbreviations - SA
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sustained action
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Abbreviations - SR
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sustained release
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Abbreviations - XR
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extended release
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Abbreviations - DS
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double strength
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Abbreviations - EC
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enteric coated
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Abbreviations - elix
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elixir (sweetened, alcohol based)
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Abbreviations - sol
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solution (clear liquid preparation)
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Abbreviations - supp
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suppository
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Abbreviations - susp
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suspension (small particles suspended in liquid)
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Abbreviations - syr
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syrup (contains sugar)
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Abbreviations - tab
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tablet (molded in solid form)
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Abbreviations - tr, tinct
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tincture (alcohol based)
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Abbreviations - oint
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ointment (semisolid preparation applied to skin)
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Abbreviations - KVO
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keep vein open
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Abbreviations - D/C
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discharge (DO NOT use for discontinue)
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Abbreviations - NKA, NKDA
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no known allergies, no known drug allergies
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Abbreviations - c
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with
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Abbreviations - s
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without
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ZERO RULE
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Zeros lead, they do not follow
ALWAYS use before decimals (0.25) NEVER use a zero after whole (1mg vs. 1.0mg) |
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Pharmacotherapeutics definition
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Pharmacotherapeutics = branch of pharmacology that involves using drugs to treat, prevent or diagnose diseases or prevent pregnancy.
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Drugs need to be (in general)...
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THERE IS NO IDEAL DRUG!! No drug is 100% safe.
All drugs are chemicals!! Drugs need to be: - Effective = elicits the response for which it is given. - Safe = a drug that doesn’t produce harmful effects. (DOES NOT exist) - Selective = a drug that elicits only the response for which it is given. (DOES NOT exist) - Reversible - Predictable - Easy to administer - Freedom from interactions with other drugs - Cheap - Chemically stable - Simple name that cannot be confused |
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Problems with public use of drugs....
And Professional Research resources..... |
FACT:52% of adults incorrectly interpreted dosage instructions for medications (Annals of Internal Medicine, 12/06)
FACT: accidental overdose and allergic reactions account for over 700,000 ER visits/yr (JAMA, 10/06) - Most common problematic drugs are insulin, coumadin (blood thinner), and amoxicillin (antibiotic). Pharmacopeia: total of all authorized drugs available in a country, containing descriptions, recipes, strengths, standards of purity, and dosage forms for the drugs. - 1906 Pure Food and Drug Act adopts USP and NF as official standards for drugs. Now called the US Pharmacopeia and National Formulary - Commonly used by pharmacists - American Hospital Formulary: extensive information on drug classes; published annually - FDA Drug bulletin: free, quarterly news letter - USP dispensing information: categories, precautions, side effects, actions, dosage and labeling information. Useful for nurses. - Package inserts: provided by manufacturer - Physician’s Desk Reference (PDR): contains information provided by manufacturer; used in clinical settings - Electronic databases: FDA webpage, Medline - Hospital formulary - Textbooks, PDA software |
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Sources of Drugs
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- Synthetic chemicals (Most are genetically engineered)
- Plants - Animals (beef, pork insulin)-only available from other countries - Mineral or mineral products - Genetically engineered chemicals |
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Drug Grouping and Nomenclature
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- Body system effect (e.g. GI drugs)
- Chemical characteristics (e.g. nervous system) - Therapeutic use (e.g. osteoporosis) - Prototypes (e.g. if you know how it works... then you can make a guess how other drugs in that category might work.) - Chemical name [We don't use], (e.g. 2-(4-isobutylphenyl)propanoic acid.) - Generic name [nonproprietary], (e.g. ibuprofen) - Trade name [brand, proprietary], (Motrin); Recognized by trademark ® |
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Legend - Definition
Over the Counter - Definition |
Legend or prescription drugs require a prescription and must bear the legend “Caution, federal law prohibits dispensing without a prescription”.
Over-the-counter (OTC) or nonprescription OTC but signature required (This is because of Meth) |
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New Drug Development Process
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New Drug Development takes many years (Patent protected 14 years). Most never make it to market.
Process monitored by Food and Drug Administration (FDA) established by Food, Drug and Cosmetic Act of 1938 U.S. is most stringent in world 5 of every 100,000 chemicals make it to market Takes about 12 years Costly-average cost to get a drug approved is $350 million Two steps: preclinical - animal testing (average of 3-5 years) clinical (four phases) Process animal testing (preclinical testing) - Two purposes: Effect in living tissue Evaluate adverse reactions Toxicity (LD 50) TI (LD 50/ED50) Investigational new drug (IND) application filed for human testing with informed consent (reviewed and approved by FDA) Phase I (healthy volunteers; small numbers; to determine metabolism, potential adverse SE) – if toxicity anticipated, volunteers with the disease Phase II (volunteers with disease/condition to evaluate safety, effectiveness and side effects; small numbers) - refining of therapeutic dose range Phase III (larger numbers of patients at research centers to find any infrequent or rare side effects). Establishes effectiveness, safety, dose range, benefit-to-risk ratio. Use a control group. - Compare to existing therapy - Placebo controlled; (always blind and double blind protocol) - New Drug Application (NDA) to FDA. Marketing begins after NDA approval. Phase IV (post-marketing surveillance to gather more information)-at least 2 years - Voluntary reporting with MedWatch - http://www.fda.gov/Safety/MedWatch/HowToReport/DownloadForms/default.htm NOTE: investigator reports to FDA after each phase and must get approval to proceed to the next phase. Expedited drug approval (e.g. AIDS drugs): Still must undergo four phases of clinical evaluation - after Phase 1 and 2 approval, process is expedited. can apply to use drugs in phase 2 or 3 if AIDS patients meet criteria (AIDS is a public health threat) Orphan drugs (1983) – tax benefits to develop drug affecting 200,000 or less Compassionate Use: Certain drugs available without FDA approval life-threatening disease can get drug without enrolling in full clinical trial Limitations of the testing procedure: - limited testing in women and children - absorption, distribution, metabolism, excretion rates MAY vary from men - menstrual cycle - safety in pregnancy - children--same issues (So basically all these testers are just really really good guesses. We don't ACTUALLY know how it will affect pregnant women or children) - failure to detect all adverse effects |
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Factors affecting an individual’s response to a drug
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- Weight-recommended dose based on 150 lb person
- Age - most drugs tested on healthy males - Gender- most tested on males - Physiologic factors-e.g. protein levels, kidney disease, - GI function - Genetic factors-some lack enzyme systems to metabolize drugs - Immunological factors-allergies - Psychological factors - Environmental factors - Tolerance (e.g. morphine) - Drug-drug interaction - Drug-food interaction |
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Effects of Drugs
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Desired effect/pharmacologic-the therapeutic effect of the drug in the body
- Acute disease - Maintenance - Supplemental (insulin) - Palliative (specialized area of healthcare that focuses on relieving and preventing the suffering of patients) - Supportive - Prophylactic Undesired/adverse effect: - Side effect-all drugs have effects other than those for which it is given - idiosyncratic-genetically determined abnormal response to ordinary dose of a drug (e.g. hypertensive crisis) - hypersensitivity/allergic-immune system recognizes drug as a dangerous foreign substance. Not dose related. Toxicity - Nephrotoxicity (a poisonous effect on the kidneys) - Neurotoxicity (alters the normal activity of the nervous system) - Ototoxicity (bad for ears) - Hepatotoxicity (bad for liver) Teratogenic (Of, relating to, or causing malformations of an embryo or fetus) Carcinogenic (radiation that is an agent directly involved in causing cancer) Mutagenic (physical or chemical agent that changes the genetic material, usually DNA) |
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Preventing Adverse Effects
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- Verify allergies; check contraindications
- Administer at recommended rate, dose, etc. - Monitor lab (if appropriate) and withhold/discontinue if indicated - Take appropriate measurements before administering drug (BP, pulse, LOC, etc.) |
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Drug Interactions - Additive
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Additive (aspirin or tylenol and codeine): two or more “like drugs”
1(Drug A) + 1(Drug B) = 2 |
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Drug Interactions - Synergistic
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Synergistic (hydroclorathiazide is a diuretic and enalapril):
two or more “unlike drugs” result in a greater effect 1(Drug A) + 1(Drug B) = 3 |
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Drug Interactions - Potentiated
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Potentiated effect (meperidine + phenergan):
effect of only one of the drugs is increased ½ (Drug A) + 1 (Drug B) = 2 |
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Drug Interactions - Antagonistic
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Antagonistic (calcium/milk and tetracycline)
1(Drug A) + 1(Drug B) = 0 |
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Drug Interactions - Incompatible
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Incompatible (IV furosemide and Heparin)
- Chemical: structure and pharmacologic properties change - Physical: precipitate |
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Drug Interactions - Food
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Fats/protein may slow absorption
e.g. Grapefruit: need to separate ingestion of grapefruit and certain drugs (numerous) by 24 hours Grapefruit blocks enzymes that break down drugs leading to toxic levels (e.g. calcium channel blockers, antidepressants, statins) |
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Off Label
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Off-label: use of a drug in ways or purposes other than what was approved by the FDA
- Different indication - Different population (e.g. for children) - Altered dose |
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Overview of Drug Legislation
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Pure Food and Drug Act of 1906 =
- Establishes USP and NF as official reference - Ingredients must be listed on label Sherley Amendment (1912) = - prohibited fraudulent therapeutic claims Harrison Narcotic Act of 1914 = - Classified certain drugs as narcotics Food, Drug and Cosmetic Act of 1938 = - Result of 100 deaths from ingestion of diethylene glycol solution of sulfanilamide - Required labeling “Warning may be habit forming” and other labeling on all drug containers - Established the FDA Durham-Humphrey Amendment of the 1938 Act in 1952 = - Differentiated drugs that could be sold without prescription from “legend drugs” - “Caution, federal law prohibits dispensing without a prepscription” Kefauver-Harris Amendment of the 1938 Act in 1962 = - Resulted from thalidamide tragedy - Protects public by ensuring that adequate preclinical testing is performed. - Must prove that drug is “safe and effective”. Informed consent. - Black box warnings - “off-label” Comprehensive Drug Abuse and Prevention Act of 1970’s = - Response to misuse and abuse of the 60’s - Classified drugs according to abuse potential C-I only with approved protocols C-II written script only, no refill C-III script expires in 6 mos (5 refills in 6 mos) C-IV same as C-III C-V written script or OTC-varies by state |
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Drug Abuse Overview
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A. Drug abuse:
- use of any drug in a manner that deviates from approved medical or social patterns - it is culturally defined (e.g. some cultures consider ingestion of any alcohol abuse) - opinions vary (some say marijuana smoking is abuse only if used habitually; is cigarette smoking abuse?) - 25-40% of hospital admissions - 50% of patients seen by family practice MD have alcohol/drug problem B. Addiction (dependence): - most commonly seen with schedule drugs Physical dependence: Physiologic reliance on a drug; withdrawal syndrome will occur if drug is discontinued Psychological dependence: intense subjective need for a particular drug Two commonly abused drugs - Alcohol - nicotine Three main drug categories of abuse - Opioids (heroin, codeine, opium, oxycodone, meperidine, etc) - Stimulants (e.g. methamphetamine, cocaine) - Depressants (benzodiazepines, barbiturates) C. Tolerance: - need to increase dose to maintain same effect with continued drug use - individual requires higher and higher doses to get same effect a lower dose once provided D. Cross-tolerance: - Tolerance to one drug confers tolerance to another drug (within the same class). F. Withdrawal - Appearance of physical symptoms due to cessation of drug use; usually opposite to drug effect |
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Pharmacokinetics
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what the body does to the drug: absorption, distribution, metabolism and excretion
the movement of drugs (what the body does to the drug) 1. Absorption - drug getting into the bloodstream, bioavailability is the amount of drug that gets into the blood; movement from site of administration to circulation. 2. Distribution - transport of drug to the site of action in the body (the target tissue) 3. Metabolism – breakdown of drug molecule (biotransformation) [all drugs are metabolized, most in the liver. usually has to be water soluble.] 4. Excretion – removal of drug from the body [most are excreted through the kidneys] |
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pharmacodynamics
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- what the drug does to the body: mechanism of action
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pharmacotherapeutics
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clinical use of drugs
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Absorption of drugs
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1. Absorption: Amount getting into blood reflects bioavailability.
Rate and extent of absorption depends on Route of Administration: a - oral (enteral); PO (per os) b - parenteral; IV, Subcu, IM, IT c - topical; transdermal, sublingual (SL), suppositories |
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Routes of Administration - Oral
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Oral (enteral) - slow and variable absorption, depends on dissolution of dosage form, pH of stomach, presence of food/fluids, rate of GI activity and GI blood flow
- Oral absorbed in GI and via hepatic portal system is shunted to liver, bloodstream. - Reduces the “bioavailability” of drugs metabolized by liver: Called “first-pass effect”. Some drugs completely inactivated by “first-pass” (nitroglycerin). - Oral route is only route with “first-pass effect”. [first-pass effect means metabolized first by liver basically] - Can cause local irritation, some drugs not absorbed by gut (insulin) - absorption can be affected by food |
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Routes of Administration - Parenteral
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Parenteral – no first-pass
Fastest and highest bioavailability= + IV direct to bloodstream (irreversible; most dangerous) - Follow rate of administration carefully!! - Properly dilute + IM – into a muscle with large blood flow - More painful than IV - Absorption varies with blood flow to area - More water soluble = rapid absorption - Good route for drugs that are absorbed slowly over time {Certain forms of penicillin] + SubQ (subcu, SC) - into the subcutaneous tissue + Epidural-into the dura of the spinal column + IT –intrathecal- into the space between the spinal cord and dura membranes (most direct) |
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Routes of Administration - Topical
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Topical – application to a body surface; bypasses first-pass
- Eye, ear gtts - Dermal – lotions, ointments on skin, slow absorption, low levels of systemic bioavailability *Transdermal-across the skin, slow and steady release, used in nicoderm - Sublingual (SL) under the tongue, highly vascular, rapid absorption - Inhalation - rectal |
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Factors affecting absoption of drugs
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- Absorbing surface (lungs, skin)-larger the area, greater the absorption
- Blood flow (SL-good, Subcu-poor; shock?) - lipid solubility-lipid soluble drugs readily cross into blood, low lipid soluble do not (Most drugs are lipid soluble) - Rate of dissolution or concentration - Form (enteric coated, non-enteric coated, liquid, etc) - Drug-drug or drug-food interactions |
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2. Distribution
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- The transportation of drugs throughout the body.
- Many drugs bind to plasma proteins (albumin) - Only unbound drugs can reach tissues; low albumin = more unbound - Two drugs can compete for protein binding sites-drug-drug interaction - Lipid solubility (better distribution than water soluble) - Blood flow to area determines rate of distribution -- Rapid = heart, kidneys, liver -- Slow = skin, muscle, fat, bone -- Brain has barrier; placenta has barrier Distribution depends on: - Blood flow to area - Lipid or water solubility -- Lipid soluble go to fatty tissue (can be stored and concentrated here) -- Water soluble remain in vascular spaces of muscle - Protein binding “Volume of distribution” or Vd– where the drug can be distributed - Highly water soluble or highly protein bound = low Vd so high blood concentration - Highly fat soluble and not protein bound = High Vd so low blood concentration; highly distributed throughout the body, more likely to cross BBB. [E.g. females have more fat so a greater Vd for lipophilic drugs—lower serum level but longer half life BUT a lower Vd for hydrophilic drugs (alcohol) so more gets to the brain] |
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3. Metabolism (biotransformation)
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Most drugs are metabolized in the liver (a few are metabolized by the kidney).
Body changing drug to a more water-soluble (polar) or inactive molecule (metabolite) - Some inactive drugs (prodrugs) change to active drugs (e.g. prodrug for morphine is codeine) - Some active drugs made more active - Some are not metabolized (e.g. garamycin) Metabolism differs by individual, disease states, genetic, and drug induced changes - e. g. Some drugs are inactivated by liver |
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Hepatic microsomal enzyme system (P450 system)
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A group of 12 enzyme families
Three of these “families” metabolize drugs - CYP1: e.g. theophylline - CYP2: e.g. omeprazole, acetaminophen - CYP3: e.g. quinidine - 95% of drugs are metabolized by CYP2 and CYP3 Nine of these “families” metabolize endogenous substances (hormones, fatty acids, etc) |
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Metabolism - Phase 1
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Metabolism involves two sets of reactions:
Phase 1- uses P450 system (cytochrome P450 or CYP 450), a micosomal enzyme system that makes drugs water soluble so they can be excreted = Contains many isoenzyme families Drugs can either be - Enzyme inducers (increase the metabolism of itself and other drugs, accelerate drug clearance and lower drug level) e.g. phenytoin, phenobarb. -- May need larger doses to get same effect -- Inducers may increase the metabolism of some hormones - Enzyme inhibitors (decrease the metabolism of drugs, lower drug clearance and increase drug level) e.g. grapefruit, ketoconazole -- Usually seen when 2 or more compete for same enzymes -- May need smaller dose to avoid adverse/toxic reaction - Not involve the enzyme system at all - Compete with another drug in the enzyme system (drug-drug, drug-food interaction) |
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Metabolism - Phase 2
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Drugs go directly to kidneys for excretion after phase 1 and skip phase 2 or be made more water soluble by “conjugation” in phase 2.
Some drugs may go directly to phase 2 and then phase 1. |
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Metabolism - End Result
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Increased drug excretion
Drug inactivation Increased therapeutic action (e.g. codeine conversion to morphine) Activation of prodrugs (a pharmacologically inactive drug converted to an active drug) Increased/decreased toxicity (e.g. acetaminophen) Other considerations: - Age - Drug-drug, drug-food interactions - First-pass |
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4. Excretion: the elimination of a drug and its metabolites from the body
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Kidney cannot eliminate lipid soluble drugs-must be metabolized first (made water soluble).
primary organ of elimination is the kidney - most metabolites made more water-soluble (polar) in the liver and leave in the urine - Also bile, bowel, lungs (anesthetics), skin, milk in nursing mothers many fat-soluble drugs excreted by the bile duct of the liver and leave in the feces-biliary excretion - bile excreted drugs may be re-absorbed in the bloodstream again and to the liver and out thru the bile duct again; this is called: (Enterohepatic circulation) |
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Excretion of lipid soluble drugs
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Pharmacodynamics
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The study of the mechanisms of drug actions in the body (what the drug does to the body). The goal is a therapeutic effect.
Ways drugs produce a therapeutic effect - receptor interaction - interactions with enzymes involved in metabolic processes - nonspecific interaction (inhibit cell wall) Receptor interactions: Drug molecule joins with a reactive site on the surface of the cell or tissue. Proteins embedded in plasma membranes of cells/neurons with specific recognition for the drug molecule. - Depends on # of receptors it interacts with |
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dr
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dram = this is a liquid measure. it is slightly less than a household teaspoon
1 dram = 4 mL 8 dr = 1 oz (fluid ounces) |
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ounce = this is a liquid measure. It is slightly more than a household ounce.
1 ounce = 32 mL |
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gtt
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Drop (latin guttae) = this liquid measure was based on a drop of water.
1 drop = 1 minim. |
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♍, ♏ m
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Minim
1 minim (m) = 1 drop (gtt) |
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ss
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one half (latin, semis)
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gr
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grain (latin, granum) = this solid measure was based on the weight of a grain of wheat in ancient times. There is no commonly used equivalent to the grain in the metric system.
DO NOT mix with gram (g) 1 grain = 60 mg (except for aspirin and tylenol which are 65 mg) |
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1 tsp =
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1 tsp = 5 mL
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1 tbsp =
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1 tbsp = 15 mL
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1 oz (fl oz) =
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1 oz = 30 mL
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1 pt =
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1 pt = 500 mL
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1 qt =
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1 qt = 1 L (1000 mL)
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2.2 lb =
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2.2 lb = 1 kg
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1 inch =
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1 inch = 2.4 or 2.5 cm
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1 cc (cubic centimeter) =
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1 cc = 1 mL (no longer used)
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Temperature conversion formula
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Remember Fahrenheit and then you'll know Centigrade
C = (F - 32) / 1.8 |
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NDC Number
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The national Drug Code is a number used by the pharmacist to identify the drug and the method of packaging
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Drug Quantity
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This information always appears on the label at either the top left, the top right, or at the bottom
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Trade Name
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A drug's trade name (also called brand name or proprietary name) is usually followed by the federal registration symbol (r). Several companies may manufacture the same drug, using different trade names. When a trade name appears on the label, it may be written either in all capital letters or with only the first letter capitalized.
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Generic Name
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The generic name is the official accepted name of a drug, as listed in the United States Pharmacopeia (USP). A drug may have several trade names but only one official generic name. The generic name is not capitalized.
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Drug Strength
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For solid drugs, the label shows metric weights; for liquid drugs, the label states a solution of the drug in a solvent.
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Drug form
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The label specifies the type of preparation in the container
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Use
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The label may include the indication for the drug
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Usual Dosage
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The dosage information states how much drug is administered at a single time or during a 24-hour period. It also identifies who should receive the drug.
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Route of Administration
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The label specifies how the drug is to be given: orally, parenterally, or topically. If the label does not specify the route, the drug is in an oral form.
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Storage
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Certain conditions are necessary to protect the drug from losing its potency (effectiveness), so this information is crucial. Some drugs come in a dry form and must be dissolved. The drug may need one kind of storage when it's dry and another kind after reconstitution.
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Precautions and Warnings
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The label may include specific instructions - related to safety, effectiveness, and/or administration - that the nurse must note and follow
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Manufacturer's Name
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If you have any question about the drug, direct them to the manufacturer
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Expiration Date
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A drug expires on the last day of the indicated month. After that date, the drug cannot be used
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Lot number
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This number indicates the batch of drug from which the stock came
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Additives
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The manufacturer may have added substances to the drug, for various reasons: to bind the drug, to make the drug dissolve more easily, to produce a specific pH, and so on. Information about such additives may appear on the label or in the literature accompanying the drug
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Drug Reconsitution
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The drug Augmentin comes in powder form. Prepare suspension at time of dispensing. The label states, "Add approximately 2/3 of total water for reconstitution (total = 90 mL); shake vigorously to wet powder. Add remaining water; again shake vigorously." This provides 100 mL suspension. Reonstituted solution contains 125 mg amoxicillin and 31.25 mg clavulanic acid (as clavulanate potassium) per mL solution.
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Ampule (Ampoule)
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a glass container that holds a single sterile dose of drug - either a liquid, a powder, or a crystal. The container has a narrow neck that must be broken to reach the drug.
Then the nurse uses a sterile syringe to withdraw the medication. Directions tell how to reconstitute the solid forms. Once the glass is broken, the drug cannot be kept sterile, so the nurse must be sure to discard any portion of the drug not immediately used. |
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Vial
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glass or plastic container with a sealed rubber top. medication in the container can be kept sterile. The container may have a sterile liquid or a sterile powder that the nurse must reconstitute with a sterile diluent and syringe. Since single-dose vials do not contain a preservative or a bacteriostatic agent, the nurse must discard any medication remaining after the dose is prepared.
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Flexible plastic bags or glass containers
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may hold sterile medication for IV use. The nurse administers the fluid via IV tubing connected to a needle or catheter placed in the patient's blood vessel
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Prefilled syringes
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contain sterile liquid medication that is ready to administer without further preparation. Although this type of unit-does packaging is expensive, it can save lives in an emergency when speed is essential.
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prefilled cartridges
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actually small vials with a needle or needleless device attached. They fit into a metal or plastic holder and eject one unit does of a sterile drug in liquid form. Brand names include Carpuject and Tubex.
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Transdermal patches or pads
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adhesive bandages placed on the skin. /they hold a drug form that is lowly absorbed into the circulation over a period ranging from hours to several days
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Lozenges, troches, and pastilles
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dislike solids that slowly dissolve in the mouth. Some drugs are prepared in a gum and are released by chewing
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Suppositories
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in foil or plastic wrappers are molded forms that can be inserted into the rectum or vagina. They hold medication in a substance that melts (such as cocoa butter) at body temperature and releases the drug. Suppositories may be used for unconscious patients or those unable to swallow.
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Plastic, disposable, squeezable containers
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hold either prepared solutions for the vagina or enema solutions that are administered rectally. To ease insertion, the containers for enemas have a lubricated nozzle. Squeezing the container forces the solution out.
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Rounding using a Syringe
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When rounding injections, current guidelines state to round to the nearest hundredth if the amount is less than 1 mL and to round to the nearest tenth if the amount is greater than 1 mL
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