CH 13 DOSAGE

Sustained released drug

-Bid -Dur Plateau Cap Span SA SR LA CR XL Sequel Spansule Extentab Tempule Chronotab Repetab Tembid.

Q

1 scored tablet

D

15 mg

Desired Dose (D) or ordered dose

15 mg mirtazapine PO now

H

30 mg

On hand (H)

30 mg scored tablets

Gelcaps

A liquid medication in a gelatin shell, not designed to be opened.

Do not crush or alter:

Any tablet with layers or speckles of different colors Tablets for sublingual or buccal use Capsules with seals that prevent separating the two parts.

If the medication cannot be crushed

Check for an alternative form Ask the physician to change the order Follow facility policy

Discard after this time period has passed

Check the label to see how long the medication may be stored (liquid medications)

What should you do before crushing tablets or opening capsules?

Check the policy, you may need a physician order first.

Tablets

Combination of an amount of drg with inactive ingredients.

Spansules

Contains granules of medication with different coatings that delay release of some of the medication. May be opened and the granules gently mixed with soft food.

Ferrous sulfate and tea

Decreased absorption

Haloperidol and coffee and tea

Decreased absorption

Erythromycin acidic fruits or juices, carbonated beverages

Decreased antimicrobial activity.

Enteric coated tablets

Deliver medication that would be destroyed by the stomach acid or that could injure the stomach lining. MUST NEVER BE CRUSHED, BROKEN, OR CHEWED.

Tube feedings

Dissolve the crushed tablet or contents of capsule in a small amount of warm water.

Enteric coated tablets Sustained-released forms of medication Any tablet with a hard shell or coating

Do not crush or otherwise alter any of the following:

Patients should

Drink at least 8 ounces of water with any medication.

If a patient has difficulty swallowing...

Drink water before taking pills Place the whole tablet or capsule in food Crush tablets (place between two spoons and use a pill crusher)

Sustained-Release Medications

Drug is released slowly into the bloodstream DO NOT CRUSH OR DISSOLVE-

enteric-coated drug

EC Enseal

Liquid Oral Meds

Greater range of dosages possible Easier to swallow for children and elderly

MAO inhibitors and foods with tryamine (hard cheeses, chocolate, red wine, and beef or chicken liver)

Headache, nosebleed, chest pain, severe hypertension.

Black cohosh, ginseng, kava kava, St. John's wort, Valerian, ETOH and CNS depressants

Intensified sedative effects of drug

What happens when CNS depressants are mixed?

Intensified sedative effects of drug

Why is not good to store medication longer than the label indicated

It may lose potency Its chemical composition may change

When coffee or tea are mixed with antipsychotics

It reduces effectiveness of drug

Where are the directions for reconstitution of a liquid medication?

Label and Package Insert

Antihistamines, cholesterol lowering agents, calcium channel blockers and grapefruit and grapefruit juice

Muscle aches, fatigue, increase i side effects.

Administration forms of tablets

Oral (swallow), sublingual, buccal, chewable, dissolvable.

Capsules

Oval shaped gelatin shells that contain medication in powder or granule form.

Caplets

Oval shaped, made with a special coating that makes them easier to swallow.

Who benefits from crushing tablets or opening capsules?

Patients who have difficulty swallowing pills or patients who have tube feedings.

Liquid Oral Medications may be less stable, so what is provided?

Powdered form

When mixing crushed tabled or opened capsules with food

Prepare tablet or capsule Mix with soft foods or liquids. Check for interactions before mixing

Tetracyclines and dairy products

Reduced effectiveness of the drug

When round small volumes, amounts less than 1 ml

Round to the hundredths

When rounding small volumes, amounts more than 1 mL

Round to the tenths

Scored Tablets

Score allows the tablet to be divided when smaller doses are ordered. Most often, scores divide tablets into halves Some divide into thirds or quarters.

Coffee and insulin

Stimulated excretion.

When caffeine and bronchodilators are mixed

Stimulation of the nervous system

Solid oral medications

Tablets Caplets Capsules Gelcaps

What do you write on the label of reconstituted liquid meds

The date and time of reconstitution Your initials

What happens when you crush or dissolve sustained-release capsules

This allows too much medication to be absorbed at one time.

Always question and verify any calculation that indicates you should give a portion of a tablet when the tablet is not scored.

True

Follow the requirements for refrigeration of liquid meds

True

H/Q = D/A

True

Household teaspoons and tablespoons do not always measure liquids accurately

True

Keep liquid medication in original container

True

Never attempt to break a tablet that is not scored

True

Read the order carefully when calculating the amount to administer

True

Reconstitute to the strength that will allow the desired dose in the smallest volume

True

When medication can be reconstituted in different strengths, write on the label the strength that you choose

True

When reconstituting liquid medications

Use only the liquid specified on the label.

Patient's must do what before dividing tablets

Wash hands break tablet along scored line use a knife or pill cutter

What should a patient do after each time of using a measuring device?

Wash it with hot water and dish detergent Dry thoroughly Store in clean container

Check the label- the reconstituted medication may need to be refrigerated

When reconstituting liquid medicationgs

Check the label- medication may need to be shaken before administering

When reconstituting liquid medications

Use the exact amount of liquid specified

When reconstituting liquid meds