DOSAGE FORMSand medication adminidtration PPT.pptx

Medication dosage forms

1. Out line Continued 1.6 Pharmaceutical dosage forms and system of measurement 1.7 .Dosage calculations 1.8 Drugs standards and nursing management 1.9 .Drugs affecting the gastrointestinal system 1.10 .Anti - inflammatory drugs 1.11 .Drugs act on respiratory system 1.12 . Drugs act on cardiovascular system 1.13 . Drugs act on the renal system 1.14 .Drugs act on endocrine system 1.15 .Drugs act on the nervous system 01/06/2024 1

2. 1.6 Pharmaceutical dosage forms and system of measurement Dosage form is a product suitable for administration of a drug to a patient. Every active ingredient (drug ) has to be formulated by adding other substances (excipients, diluents, preservatives vehicles, etc.) according to a specific recipe and packaged into a specific 'dosage form' such as tablet , elix ir , ointment. injection vial, etc . 01/06/2024 2

3. Dosage administration aids (DAA) A DAA is a device or packaging system such as blister packs, bubble packs or sachets for organizing doses of medicines according to the time of administration. The use of DAAs in conjunction with medication charts or records are to be used by support/care workers in assisting with medication instead of using medicine in its original packaging such as bottles. This ensures greater safety for the client as mistakes are less likely to be made. 01/06/2024 3

4. Dosage administration aids (DAA) Dose Administration Aids are designed to assist people in safely and effectively taking their prescribed medicine. DAAs usually are packed by a Pharmacist. When a person has many medicines or a complicated medication regime, DAAs makes taking medication simple as the medications are grouped according to the time of day they are taken. Commonly they have 4 different times for administration of medication, breakfast, lunch , dinner and bedtime. Only solid oral medicines can be packed into a DAA. All other medication is then referred to as non-packed medication. This includes medicines formulated as drops, sprays, patches or creams. 01/06/2024 4

5. Dosage administration aids (DAA) DAAs also have the same details and information on them as on a medication chart namely: Client identification details, photo Doctor‟s particulars Pharmacy details Names of the medicines ordered for that day and time and information 01/06/2024 5

6. Dosage administration aids (DAA) Which medicines can or can't be crushed Specific instructions about the use of the medicines such as cautionary and advisory labels. Examples include information about whether the medication can or shouldn't be crushed, should be kept away from light etc. It also should be labeled keep out of reach of children. 01/06/2024 6

7. M ulti- dose Webster and Webster pak 01/06/2024 7

8. Dosage form of medication Dosage forms are the means (or the form) by which drug molecules are delivered to sites of action within the body. They are classified according to: A. Route of administration Oral Topical Rectal Parenteral Vaginal Inhaled Ophthalmic Otic 01/06/2024 8

9. Dosage form of medication Cont …d B. Physical form Solid Semisolid Liquid Gaseous 01/06/2024 9

10. Solid dosage forms Powders: The drug is in a dry and finely pulverized state. If the drug is for oral administration , each dose has to be wrapped separately or packed in sachets; therefore this dosage form is inconvenient and unpopular except when the quantity is several grams. e.g. oral rehydration salts. Powders for topical application (dusting powders) are supplied as bulk powders in metallic or plastic containers with holes for sprinkling. 01/06/2024 10

11. Common Forms of Medications Tablets Capsules Liquid Suppository Ear-drops Eye-drops Inhalants Lotion and cream Nose-drops Ointments Patches Powder 01/06/2024 11

12. Common Forms of Medications I. Tablet Hard , compressed medication in round, oval, or square shape o Some have enteric coating or other types of coatings, which delay release of the drug and can not be crushed or chewed 01/06/2024 12

13. Tablet medications 01/06/2024 13

14. II. Capsule II. Capsule In a gelatin container that may be hard or soft Dissolves quickly in stomach 01/06/2024 14

15. III. Liquid D ifferent types of liquid medications a. Solution - a liquid containing dissolved medication or Suspension Suspensions are dispersion of insoluble drugs in water with the help of a suspending agent . Emulsions are uniform mixtures of two immiscible liquids (mostly oil and water ) 01/06/2024 15

16. III. Liquid Both suspensions and emulsions, a liquid holding un dissolved particles, tend to settle down on keeping; should be shaken thoroughly before use. - a liquid holding un dissolved particles of medication that must be shaken before measuring and administering to resident b . Syrup - a liquid medication dissolved in a sugar water to disguise its taste c. Elixir - a sweet alcohol based solution in which medications are dissolved 01/06/2024 16

17. IV. Suppository Small solid medicated substance, usually cone-shaped Melts at body temperature May be administered by rectum or vagina Refrigerate as directed by manufacturer Usually oval or suitably shaped bodies for vaginal insertion are called ' pessaries ', 01/06/2024 17

18. V. Inhalant/Inhalations Drugs which are gases or volatile liquids can be administered by inhalation carried into air or oxygen with the help of a mouth piece, face mask, hood or endotracheal tube. Medication carried into the respiratory tract using air, oxygen or steam Inhalants may be used orally or nasally 01/06/2024 18

19. VI. Topical Applied directly to the skin surface. Topical medications include the following: a. Ointment - are greasy semi solid preparations meant for external application to the skin, eye, nasal mucosa, ear or anal canal . Ointments are not suitable for oozing surfaces , because they are more occlusive and do not allow evaporation of water. Rather they are good for dry, chronic lesions . b. Creams -- are similar to ointment but the base is a water in oil emulsion . The medicament is better absorbed into the skin from creams than from ointments, and creams are cosmetically more acceptable than ointments . 01/06/2024 19

20. Topical medications Cont…d c. Lotion - These are solutions, suspensions or emulsions meant for external application to the skin without rubbing. They generally have soothing , cooling , protective or emollient property and are better suited than creams or ointments for hairy skin . 01/06/2024 20

21. Topical medications Cont…d d. Paste - a semisolid substance thicker and stiffer than an ointment containing medications Pastes are non greasy preparations of thick consistency containing hydrophilic adhesive powders. Pastes can be applied to inflamed or excoriated skin, oozing surfaces. and mucous membranes. Toothpastes are items of personal hygiene 01/06/2024 21

22. Topical medications Cont…d e . Gels- The medicament is incorporated in a viscous colloidal solution of gelatin or similar material and is usually dispensed in collapsible tubes . Gels are suitable for application to hairy skin, and are commonly applied to oral ulcers because they are better retained than aqueous solutions. f. Patches (transdermal) - medication encased in a round, square, or oval disc that is affixed to the skin 01/06/2024 22

23. VI. Topical Topical medications Cont ….d g. Powder – fine, ground form of medication that may be used to be swallowed , or may be used as on the skin for rashes. e.g. oral rehydration salts. h. Aerosol sprays – solution that holds the medication suspended until it is dispensed in the form of a mist to spray on the skin 01/06/2024 23

24. Dose , Dosage and Dosage Regimen Dose , dosage and dosage regimens are mistakenly used as synonyms . However, there is a difference among these terminologies. While dose is specific quantity of a therapeutic agent to be administered in a given instance, or measured to be taken at one time; dosage is a broader term that represents both the size of the dose in question as well as the intervals at which the dose is to be taken. 01/06/2024 24

25. Dose , Dosage and Dosage Regimen Dosage regimen is the scientific schedule based on patient characteristics that include a specific amount, number, and frequency of doses over a specific period of time. 01/06/2024 25

26. Dose , Dosage and Dosage Regimen b) Units for Doses Drug doses are expressed in conventional metric mass units (for example, milligrams or milligrams per kilogram). Moreover, certain drugs (such as insulin or heparin) may be prepared as mixtures and have no specific molecular weight, thereby precluding their expression in mass units. 01/06/2024 26

27. Dose , Dosage and Dosage Regimen Some drugs such insulin are measured in units Insulin is most commonly supplied as 100 units/ml Insulin is administer using an insulin syringe which is calibrated in units. 01/06/2024 27

28. Common Metric Conversions in Medication Calculations Metric Measurement & Common Conversions of solid. 1 kilogram(kg ) 1 kg = 1000 grams 1 kg = 2.2 Pounds ( lb ) 1 gram = 1000 milligram (mg) 1 gm = 10 Decigram 1 Grain(gr) = 60 mg 1 miligram (mg) = 1000 Microgram (mcg) 1mcg = 1000 nanogram ( ngm ) 01/06/2024 28

29. Common Metric Conversions in Medication Calculations Standard Measurement & Common Conversions of fluid 1 liter = 1000 mL = 1000 cc 1 teaspoon ( tsp ) = 5 mL 1 tablespoon ( Tbsp ) = 15 mL 1 ounce ( oz ) = 30 mL 1 deciliter ( dL ) = 100 ml 1 deciliter  ( dL ) = 1/10 of a liter. 1 ml = 15 drops ( gtt ) or (20gtt) 01/06/2024 29

30. Dose , Dosage and Dosage Regimen Approximate Conversion Factors of Length 1 Kilometer (km) = 1000 Meter (M) 1M = 100 centimeter (cm) 1cm = 10 millimeter (mm) 1 Inch = 2.54 cm 1 Millimeter (mm) = 1000 Micrometer ( µg ) 1 Microgram = 1000 Nanogram ( ng ) 01/06/2024 30

31. 1.7 .Dosage calculations Drug Dosage Calculations Drug dosage calculations are required when the amount of medication ordered (or desired) is different from what is available on hand for the nurse to administer. Formula: 01/06/2024 31

32. Example 1 Cont….d Example 1: The Physician ordered a certain tablet of 50 mg PO. The tablet is available as 100 mg per tablet. How many tablets would the nurse administer? Step 1: Determine your givens. Amount desired (D) = 50 mg Amount on hand (H) = 100 mg /tablet Quantity = 1 01/06/2024 32

33. Example 1 Cont….d Step 2: Plug in what you know into the formula and simplify. x 1 = 0.5 tablet Therefore, the nurse would administer 0.5 of a tablet.   01/06/2024 33

34. Example 2: The Physician ordered a certain tablet of 1200 mg PO. The tablet is available as 6 00 mg per tablet. How many tablets would the nurse administer ? Step 1: Determine your givens. Amount desired (D) = 1200 mg Amount on hand (H) = 600 mg /tablet Quantity = 1 01/06/2024 34

35. Example 2: Step 2: Plug in what you know into the formula and simplify. x 1 = 2 tablets Therefore, the nurse would administer 2 tablets.   01/06/2024 35

36. Example 3: The same formula can be used for dosage calculations where the medication is available as amount per certain volume . In these types of calculations, the volume available on hand is the QUANTITY . Amoxicillin suspension is available as 125 mg/5 mL. The health care provider ordered 250mg PO TID. How much mL should the nurse administer to the patient? 01/06/2024 36

37. Example 3: Step 1: Determine your givens. Amount desired (D) = 250 mg Amount on hand (H) = 125 mg Quantity = 5 mL Step 2: Plug in what you know into the formula and simplify . x Quantity = Y (Volume Required   01/06/2024 37

38. Example 3: Solution: x 5ml = 10 ml Therefore, the nurse would administer 12 mL. Example 4: Furosemide is available as 40 mg in 1 mL. 10 mg is ordered to be administered through an IV. What amount of furosemide should the nurse administer?   01/06/2024 38

39. Example 4 : Example 4: Furosemide is available as 40 mg in 1 mL. 10 mg is ordered to be administered through an IV. What amount of furosemide should the nurse administer? 01/06/2024 39

40. Example 4: Step 1: Determine your givens. Amount desired (D) = 10 mg Amount on hand (H) = 40 ml Quantity = 1 mL Solution: x 1ml = 0.25 ml Therefore, the nurse should administer about 0.3 mL of furosemide.   01/06/2024 40

41. Dosage Calculations based on Body Weight Dosage calculations based on body weight are required when the dosage ordered and administered is dependent on the weight of the patient. For example, many pediatric drugs are ordered and given per weight (usually in kg ). Dosage calculations based on body weight are calculated in two main stages. 01/06/2024 41

42. Dosage Calculations based on Body Weight Stage 1: Using the formula below, calculate the total required dosage based on given the body weight Weight (kg) x Dosage Ordered (per kg) = Y (Required Dosage) Stage 2: Apply the x Q formula to calculate the actual amount (ml) of medication to be administered.   01/06/2024 42

43. Dosage Calculations based on Body Weight Example 1: Gentamycin 7.5mg/kg in two divided dose is ordered for a child weighing 30 pound ( lb ). Gentamyci n is available as 80 mg/2mL . How many milliliters of medication must the nurse administer? Step 1: Determine your givens. Weight: 30 lb Dosage ordered: 7.5mg/kg Available on hand: 8 0 mg/2mL 01/06/2024 43

44. Dosage Calculations based on Body Weight Example 1:Cont…d Solution: Step 1: Weight (kg) x Dosage Ordered (per kg) = Y (Required Dosage ) Wt. 30 Ib = 30/2.2 =13.6kg 13.6kg x 7.5 mg = 102 mg/d, in 2 divided doses. Therefore, one time dose is: 102mg/2 = 51mg 01/06/2024 44

45. Dosage Calculations based on Body Weight Example 1: Cont…d Solution: Step 2 : x Q = actual ml of medication to be administered. D = 51mg x 2mL = 1.3 mL H= 80mg Q= 2mL Actual mL= ? Therefore , the nurse should administer about 1.3 mL of Gentamycin.   01/06/2024 45

46. Calculation of Intravenous Drip Rates In these types of calculations, for a given volume, time period, and drop factor ( gtts /mL), the required IV flow rate in drops per minute ( gtts /min) is calculated. Note: Since a fraction of a drop is not possible to give to a patient, it is usual to round the answers to the nearest whole number. Formula: x Drop factor(gtt/min) = Y (flow rate in gtts /min)   01/06/2024 46

47. Drip Rates Cont…d Example 1: Calculate the IV flow rate for 250 mL of 0.5% dextrose to be administered over 3 hours. The infusion set has drop factor of 15 gtts / mL. Step 1: Determine your givens. Volume= 250ml of DW. Time = 3 hours Sol.= x Drop factor = x 15 gtts /min = =20.8=21 Therefore, the IV flow rate is 21 gtts /min.   01/06/2024 47

48. Drip Rates Cont…d Exercise: Calculate the IV flow rate if 2 L IV Normal saline is ordered to be infused over 12 hours. 01/06/2024 48

49. Calculation of Flow Rate for an Infusion Pump Example 2: 600 mL of Quinine is to be infused over the 180 minutes by an infusion pump. Calculate the flow rate (mL per hour). Step 1: Determine your givens. Volume : 600 mL Time : 180 min Step 2: Convert 180 min into hours since the flow rate must be stated in mL/h. 180 min ÷ 60 min/h = 3 h Step 3: Calculate the flow rate in mL/h using the formula: = Y(flow rate in mL/ hr ) = 200mL/ hr Therefore, the flow rate is 200 mL/h.   01/06/2024 49

50. Pediatric Dosing Formula 01/06/2024 50

51. Pediatric Dosing Formula Eg. What is the dose salbutamol for a one & half year old child if the adult dose is 4mg? Use Fried’s rule. Given: Childs age 1&1/2 year = 18 months Adult dose = 4mg Child dose = X Adult dose Child dose= X 4mg = 0.5mg   01/06/2024 51

52. 1.8 Drugs standards and nursing management Definition of Medicines Management: “The facilitation of safe and effective use of medicines.” The standards describe the responsibilities and conduct expected of nurses in their involvement with medicines across all care settings. They are intended for use alongside the policies, procedures, protocols and guidelines (PPPGs) of the health service organization. 01/06/2024 52

53. 1.8 Drugs standards and nursing management Standard 1: Patients have a right to receive their medicines from a nurse or midwife who understands the purpose of the drug regimen and its associated risks and benefits. You should support the patient in taking their medicines safely within an agreed model. 01/06/2024 53

54. 1.8 Drugs standards Cont….d Standard 2 : You must be aware of your legal and professional responsibility and accountability with regard to medicines management to ensure that patients receive the maximum benefit from their medicines . 01/06/2024 54

55. 1.8 Drugs standards Cont….d Standard 3: You should have access to medicines based on patient need, and there are local systems in place to support this. 01/06/2024 55

56. 1.8 Drugs standards Cont….d Standard 4 : You must understand the purpose of the prescription or medicines order, and be absolutely clear as to the written or printed directions. Also , you should seek further information, advice and guidance if necessary before administering any medicinal product. 01/06/2024 56

57. 1.8 Drugs standards Cont….d Standard 5: You are accountable for all actions and omissions relating to your role in administering a prescribed medicine. 01/06/2024 57

58. 1.8 Drugs standards Cont….d Standard 6 : Following the administration of a medicine, you must monitor that the desired effect of the medicine has been achieved, and participate in a review of the medicines. 01/06/2024 58

59. 1.8 Drugs standards Cont….d Standard 7: You may decide to withhold a medicine based on a specific clinical rationale or respecting the patient’s own decision to refuse their medicines. Standard 8: You must adhere to the requirements of the Misuse of Drugs Acts and Regulations, given the serious nature of the drugs and their potential for misuse or abuse, follow a strict regimen of control of these substances at all times. 01/06/2024 59

60. 1.8 Drugs standards Cont….d Standard 9: You must have a thorough understanding of the factors involved in adverse events or reactions. You must also recognize the high importance of reporting every medicine related error, whether actual or potential, and implement remedial action. 01/06/2024 60

61. 1.8 Drugs standards Cont….d Standard 10: You must understand the rationale for the drug prescription and the potential side effects of the drug in order to be able to identify, intervene and report a suspected adverse event or reaction. Standard 11: You must work with the patient and, where appropriate, their families and care takers in medicine reconciliation. You must also work in association with other healthcare professionals to ensure that people do not suffer unnecessarily from the excessive, inadequate or inappropriate use of medicines. 01/06/2024 61

62. 1.8 Drugs standards Cont….d Standard 12: You should understand the complex factors that influence the patient’s decision-making process and adherence regarding their medicines. Education should be provided to the patient and their family in relation to the use of medicines. It should be explained to the person in a way that is accessible and understandable. 01/06/2024 62

63. The role of the nurse in safe medicines management The role of the nurse and midwife in safe medicines management encompasses understanding the purpose of the patient’s medicine regimen, supporting the safe administration of medicines, monitoring the effectiveness of medicines and the patient’s understanding and adherence. It is not solely a mechanistic automatic task, but ensures that the patient gets the maximum benefit from the medicines they need while, at the same time, minimizing the potential for harm. 01/06/2024 63

64. Patient Safety 01/06/2024 64

65. Patient Safety Cont …d Patient safety must be the priority in every setting, and has been defined as the freedom from accidental injury . The nurse: Understands the purpose of the patients’ medicines regimen; Can read the prescription clearly ; Understands the risks and benefits of each medicine ; Adheres to the “Ten Rights” for the safe administration of medicines; 01/06/2024 65

66. Patient Safety Cont …d The nurse Cont …d Monitors the effectiveness of specific medicines; Ensures that the patient understands their medicines including discussion on quality of life issues; Discusses the potential difficulties with adherence to regimen; Advises on medicines management follow up and review . 01/06/2024 66