oral medication

Insulin is measured in international units (IU) -

a term that refers to a drug's activity, not its weight.

bsa+ metric

squar root of (kg*cm)/3600

The most commonly used syringe in small-animal veterinary practice is the

the 3 mL (also known as the 3 cc) syringe

A milliequivalent is an expression of the number of grams of a drug contained in one milliliter of solution.

Pharmaceutical companies label electrolytes (sodium chloride, potassium chloride, and calcium chloride, for example) in milligrams as well as in milliequivalents.

titration.

The process of adjusting the dosage of a medication based on patient response

A patient is to receive 150 mg of a drug IVPB in 200 mL NS over 1 hour. The vial of medication indicates a strength of 75 mg/mL. (a) How many milliliters must be withdrawn from the vial and added to the NS? (b) At what rate in mL/h should the pump be set?

2ml 200ml/h

The prescriber ordered: 250 mL 5% D/W with 60 mg of a drug 0.006 mg/kg/min IVPB daily. The patient weighs 75 kg, and the drop factor is 20 gtt/mL. Calculate the flow rate for this drug in drops per minute.

37.5gtt/ml

drugs, such as electrolytes, are measured in

milliequivalents (mEq)

blood glucose measured in

milligrams per deciliter (mg/dL)

1 mL=1 cc=1 g

1% = 1 g/100 mL

Order: Lactated Ringer's at 167 mL/h IV for 6 h. How many millili- ters will the patient receive in 6 hours?

1,002 mL of Lactated Ringer's.

Order: heparin 40,000 units continuous IV in 1,000 mL of D5W infuse at 30 mL/h. Find the rate in units/day, and determine if it is in the safe dose range (the normal heparinizing range is between 20,000 to 40,000 units per day).

28800u/d and yes

A 5-kg cat needs 12 mg/kg thiopental. How much 2.5% thiopental will you draw up?

2.4 ml

A 10-kg dog requires a drug to be given by continuous infusion at a rate of 1 mg/kg-h using a maintenance fluid rate of 50 mL/kg over 24 hours. How many mg of drug are to be added to 1 L of fluids?

480mg

medication cups cannot accurately measure volumes less than

5 mL

How many mL of U-100 insulin will be used in 1 week for a 35-lb dachshund that is on a dose of 3 IU/kg twice daily?

6.7 ml

mircodrops/ml

60mcgtt/ml

Calculate the number of units of Humulin R a patient is receiving per hour if the order is 500 mL NS with 300 units of Humulin R infuse at the rate of 12.5 mL per hour via the pump.

7.5u/h

a syringe with a needle and without a need are called

When fitted with a needle, it is called a hypodermic syringe and may be used to inject medication into the body. Oral syringes (without the needles) are used to administer medication orally

Remember to check the label for the correct drug and dosage when

1. You remove it from the pharmacy shelf 2. You dispense the medication 3. You replace the medication.

When you reconstitute a multiple-dose vial of powdered medication, it is important that you clearly label the vial with the following:

1. date and time of preparation 2. strength of the solution 3. date and time the reconstituted solution will expire 4. storage directions 5. your initials

25 mL of a 4% thiopental solution is drawn up. How many mg of drug does this represent?

1000mg

750 mg of a drug is ordered IVP stat over 5 minutes, and the concen- tration of the drug is 75 mg/mL. (a) Find the total number of milliliters you will administer. (b) Determine the IVP flow rate if you divide the infusion into 5 equal segments. (c) Determine the IVP flow rate if you divide the infusion into 10 equal segments.

10ml 2ml 1ml

A 20-kg dog is prescribed a drug to be given at a constant rate infusion of 5 mg/kg every 24 hours. The drug has a strength of 10 mg/mL. What volume of drug is infused over 24 hours?

10ml/24h

The order reads 125 mL 5% D/W IV in 1 hour. What is the flow rate in microdrops per minute?

125 microdrops per minute.

A patient must receive a drug at the recommended rate of 15 mg/kg/d. (a) If the patient weighs 100 kg, how many mg/d must the patient receive? (b) The drug is to be administered IVPB in 200 mL D/5/W over 60 min. The vial contains 1.5 g of the drug in powdered form. Find the IV flow rate in mL/h. (c) How many mg/min will the patient receive?

1500mg/d 200ml/h 25mg/min

Order: Cefizox (ceftizoxime sodium) 1,500 mg IVP stat over 4 min. The 2 g Cefizox vial has strength of 1 g/10 mL. (a) Find the total number of milliliters you will administer. (b) Determine the number of mL you will push during each 30-second interval. (c) Determine the number of seconds needed to deliver each 1 mL of the solution.

15ml 1.85ml 16sec

The order is: a drug 100 mg/m2 IVPB in 250 mL NS infuse over 3 h. The patient's BSA is 1.65 m2, and the drug is available in a vial labeled 60 mg/mL. (a) How many milligrams of the drug must the patient receive? (b) How many milliliters must be withdrawn from the vial and added to the IV bag? (c) The order indicates that the drug should be added to 250 mL of NS. At what rate in mL/h should the pump be set?

165mg 2.75ml 84ml/h

The prescriber writes an order for 1,000 mL of 5% D/W with 10 units of Pitocin (oxytocin). Your patient must receive 3 mU of this drug per minute. Calculate the flow rate in microdrops per minute.

18mcggt/1min

parenteral administration refers to giving drugs

'in the space between the enteric canal and the surface of the body.

A 5-kg diabetic cat needs a constant infusion of insulin of 0.05 units/kg each hour. It is on maintenance fluids of 60 mL/kg every 24 hours and a 60 gtt/mL drip set is in use. The insulin concentration is 40 IUs/mL. How many mL of insulin will you add to a 250-mL bag of fluids?

0.25ml

A drug with a concentration of 1 mg/mL was infused into a patient. The 4-kg patient received 15 mL of this drug in 10 hours. What was the infusion rate in mg/kg-h? Note: This is a similar question to the previous ones but 'in reverse.' Work backwards to find your answer.

0.38mg

An IV bag contains 1,000 mL of NS with 500 mg of a drug. It is infusing at 12 gtt/min. The drop factor is 10 gtt/mL. (a) Find the dosage rate in mg/min. (b) If the recommended dose is 0.5-2.5 mg/min, is this infusion in the safe dose range?

0.6 mg/min no yes

cimetidine 300 mg IVPB q6h in 50 mL NS infuse in 20 min. Find the (a) IV flow rate measured in milliliters/min. (b) Dosage rate measured in milligrams/min.

2.5 ml/min 15mg/min

How much diluent do you add to make 100 mL of a 4% solution using a 20% stock solution?

20 ml stock to 80 diluent

D5/W has been infusing at 30 mL/h IV for 8 hours. How many milliliters have infused?

240 mL of D5/W have infused

The patient weighs 80 kg and must receive dopamine hydrochloride at the rate of 3 mcg/kg/min. How many mg/min should the patient receive? How long will it take for the patient to receive 50 mg of the drug?

2400mg/min 208 min

The medication order reads: heparin 1,250 units/hour IV. (50units/ml) a. Calculate the infusion rate in mL/h

25uints/h

Using a 70% solution of alcohol, make 200 mL of a 10% solution.

28.6 ml alcohol to 171.6 solution

Order: cefoxitin 1 g IVPB q6h over 30 minutes. (1g/50ml) (a) Find the dosage rate in grams per hour. (b) Find the dosage rate in milligrams per minute.

2g/hour 34 mg/min

An IV of 1,000 mL D5 and 1/2 NS has been ordered to infuse at 25 gtt/min. The drop factor is 20 gtt/mL. If the IV was hung at 10 p.m. on Tuesday, how many milliliters will have infused by 2:30 a.m. on Wednesday?

338 mL will have infused by 2:30 a.m. Wednesday.

An 8-kg terrier usually requires 15 mg/kg of thiopental for anaes- thetic induction (this is an injection given to anaesthetize an animal before using a gaseous anaesthetic). How much of the 2.5% drug will you draw up into a syringe?

4.8 ml

Order: NS 1,000 mL continuous IV for 24 hours. Find the pump set- ting in milliliters per hour. To find the flow rate,

42 mL/h.

. A 24-lb dog needs a drug infused at a rate of 0.2 mg/kg-h. Using a drug with a strength of 5 mg/mL, how many mL of the drug will be needed for 12 hours?

5.2ml

A 12-lb cat needs 1 IU/kg of insulin once a day. Using U-40 insulin, how many units are given each day?

5.5 IU

From a 50% solution of dextrose, make 500 mL of a 5% solution.

50 ml dextrose to 450 solution

How many milliliters of D5W will infuse intravenously in 10 hours at the rate of 13 gtt/min? The drop factor is 15 gtt/mL.

520 mL will infuse in 10 hours

A patient is receiving an infusion of a drug at the rate of 3 units/min IVPB. The bag contains 250 units of the drug in 100 mL of solution. (a) How many units of the drug will the patient receive in 20 minutes? (b) How many minutes will it take for 50 mL of the solution to infuse?

60u 42min

To induce labor, the order is: Pitocin (oxytocin) start at 1 mU/min IV, may increase by 2 mU/min q15 min to a max of 11 mU/min. The IV strength is 10 mU/mL. (a) Calculate the initial pump setting in mL/h. (b) Construct a titration table for this order

6ml/h max at 12ml/h

The prescriber ordered: Ifex (ifosfamide) 1.2 g/m2/d IVPB, infuse over 30 min. Repeat for 5 consecutive days. The IV solution strength is 50 mg/mL. The patient has BSA of 1.50 m2. Find the flow rate in mL/h.

72ml/h

A patient must receive a tube-feeding of Ensure 120 milliliters in 90 minutes. Calculate the flow rate in milliliters per hour. To find the flow rate,

80 milliliters per hour.

A patient is receiving an infusion at 0.5 mg/min. The concentration in the IVPB bag is 100 mg in 200 mL. (a) How long will it take for the patient to receive 40 mg? (b) How many milliliters will the patient receive in 30 minutes

80min, 1hour 20min 30mins

If you accidentally used a U-40 syringe to draw up U-100 insulin, how many units would actually be contained in the syringe that is drawn to the 20 IU mark?

8IU

A 10-kg dog is receiving fluids at a rate of 40 mL/h. It needs a drug added to 500 mL of fluids so that it receives 2 mg/kg each hour. The drug has a strength of 2%. What volume of drug will you add?

Add 12.5 mL of drug to 487.5 mL of fluid and infuse at a rate of 40 mL/h.

For a 5 kg dog, BSA would be

BSA = 0.101 × 50.67 BSA = 0.29 m2

A syringe consists of a barrel, a plunger, and a tip. ● ● ●

Barrel: a hollow cylinder that holds the medication. It has calibrations (graduated markings) on the outer surface. Plunger: fits in the barrel and is moved back and forth. A rubber stop- per attached to the plunger has two rings that fit snugly into the barrel. Pulling back on the plunger draws liquid or air into the syringe. Pushing in the plunger forces air or liquid out of the syringe. Tip: the end of the syringe that holds the needle. The needle slips onto the tip or can be twisted and locked in place (Luer-LokTM).

pump can be programmed to deliver a basal rate and/or a bolus dose.

Basal insulin is delivered continuously over 24 hours to keep blood- glucose levels in range between meals and overnight. The basal rate can be programmed to deliver different rates at different times. Bolus doses can be delivered at mealtimes to provide control for additional food intake.

An IV of 1,000 mL of 5% D/0.9% NaCl is started at 8 p.m. The flow rate is 38 drops per minute, and the drop factor is 10 drops per milliliter. At what time will this infusion finish?

So, the infusion will take 4 hours and 23 minutes. Because the infu- sion began at 8 p.m., it will finish at 12:23 a.m. the next day.

How many 8-unit doses will a 10mL vial of u100 make

So, the vial contains 125 doses

dosage calculation problems usually involve the following three parameters:

The patient's weight The prescribed dose of medication The concentration (strength) of the medication

Insulin comes in two common strengths:

U-100, which has 100 units per mL U-40, which has 40 units per mL

A 4-kg cat is prescribed a drug at 2 mg/kg-24 h and the drug has a concentration of 1 mg/mL. The drug is to be added to a 500-mL bag of saline solution that is given at a rate to meet maintenance require- ments of 60 mL/kg-24 h. How much of the drug is added to the 500- mL bag of fluids and at what rate is the fluid/drug mixture given?

We would add 16.7 mL of the drug to 483.3 mL (500 − 16.7) of i.v. fluids and then administer the combination at the rate prescribed: 10ml/h

A secondary line is referred to as a piggyback or intravenous piggyback (IVPB).

With intermittent IVPB infusions, the bags generally hold 50-250 mL of fluid containing dissolved medication and usually require 20-60 minutes to infuse.

syringe is

a device used to draw in or eject either air or liquid.

three-way safety check is

a method of ensuring the correct medication is used each time.

A ratio is

a way of demonstrating the relationship between two numbers.

Order: NS 600 mL IV infuse in 5 hours stat. (a) Calculate the initial pump setting in mL/h. (b) When the nurse checks this infusion 2 hours later, 330 mL are LIB (left in the bag). Recalculate the pump setting for the remaining 330 mL. (c) If the facility protocols indicate that flow rate adjustments must not exceed 20% of the original rate, may the adjustment be made?

a- 120ml/h b- 110ml/h c- yes 8%

The order reads 1,000 mL D5W IV over 8 hours. The drop factor is 10 gtt/mL. (a) Calculate the initial flow rate in gtt/min for this infusion. (b) After 5 hours, 700 mL remain to be infused. How must the flow rate be adjusted so that the infusion will finish on time? (c) If the facility has a policy that flow rate adjustments must not exceed 25% of the original rate, is the required adjustment within the guidelines?

a-21ml/min b-39ml/min c=no 86%

advantages to parenteral administration including

almost 100% bioavailability of the drug

The larger sizes syringes (5, 12, and 35 mL) are commonly used to .

draw blood or prepare medications for intravenous administration

It is best to administer the ____ number of tablets or capsules possible.

fewest

Whenever possible, it is preferable to obtain the medication in the same strength as the dose ordered, or

if that is not available, choose a strength that equals a multiple of the prescribed dose.

The smaller-capacity syringes (0.5, 1, and 3 mL) are used most often for

intradermal, subcutaneous, or intramuscular injections of medication.

The drip rate

is the number of drops to be infused per minute. divide the total milliliters needed by the total time prescribed for the infusion, and then multiply that figure by the drop factor.

An IV of 5% D/W is infusing at a rate of 20 drops per minute. If the drop factor is 15 drops per milliliter, how many hours will it take for the remaining solution in the bag to infuse (300ml)

it will take 3 3/4 hours for the remaining solution to infuse.

Suppose an order indicates that a certain drug must be administered with an initial dosage rate of 10 mcg/min and that the rate should be increased by 5 mcg/min every 3-5 min for chest pain until response, up to a maximum rate of 30 mcg/min. The IV bag has a strength of 50 mg/250 mL.

iv rate starts at 3ml/h 4.5ml/h max at 9ml/h

BSA (in m^2) = k × BW^x

k is a constant (0.101 in dogs, 0.1 in cats) BW is body weight in kg x = 2⁄3, or 0.67

In veterinary medicine, the two most common flow rates are

mL of i.v. fluids per hour (mL/h) and L of oxygen per minute (L/min) during anaesthesia.

A patient who weighs 55 kg is receiving a medication at the rate of 30 mL/h. The concentration of the medication is 400 mg in 500 mL of D5W. The recommended dose range for the drug is 2-5 mcg/kg/min. Is the patient receiving a safe dose?

no 400mcg/min

The recommended dose of medication for a particular patient is affected by several factors,

patient's weight age body surface area (BSA) general physical condition presence of liver and kidney disease, and the severity of illness.

Insulin is supplied as a liquid measured in standardized units of

potency rather than by weight or volume. These standardized units are called USP units, often shortened to units.

Disadvantages to parenteral administration including

potential pain for the patient a higher degree of technical ability on the part of the clinical staff

Medications for oral administration can be found in

solid, liquid, and milliequivalent forms.

bsa= household

squar root of (lb*in)/3131

Solutions can be expressed as a weight/volume (w/v) per- centage, as with the thiopental above, or as a volume/volume (v/v) percentage

such as a 2% hydrogen peroxide solution. This represents 2 mL of hydrogen peroxide in 100 mL of total solution.

The dose of a medication is

the amount that will produce the desired medical effect.

The length of the needle is The gauge of the needle refers 8 to the thickness of the needle and varies from 18 to 28 (the larger the gauge, the thinner the needle).

the distance from the point to the hub. Needles most commonly used in medication administration range from 3 inch to 2 inches. refers 8 to the thickness of the needle and varies from 18 to 28 (the larger the gauge, the thinner the needle).

The prescriber ordered 1 NS 850 mL IV in 8 hours. The IV set to used (10ggt/ml) Calculate the flow rate in drops per minute.

the flow rate is 18 drops per minute

The prescriber orders D5/0.45% NaCl IV to infuse at 21 drops per minute. If the drop factor is 20 drops per milliliter, how many millili- ters per hour will the patient receive?

the flow rate is 63 mL per hour.

Order: 1 NS 1,000 mL IV at 50 mL/h. If the IV starts at 1200h on 125 mL/h 2 Monday, at what time will it finish?

the infusion will finish at 0800 h on Tuesday

Order: 0.9% NaCl 500 mL IV at 125 mL/h. How long will this infu- sion take?

the infusion will take 4 hours.

The solvent (diluent) is

the liquid that dissolves the solid solute or dilutes the liquid solute. Two commonly used solvents are sterile water and nor- mal saline.

the shaft

the long tube that is embedded in the hub;

The drop factor is

the number of drops per milliliter; drops per minute (gtt/min) or microdrops per minute (mcgtt/min)

A proportion demonstrates

the relationship between two ratios.

Order: For every 100 mL of urine output, replace with 40 mL of water via PEG tube q4h. The patient's urine output is 300 mL. What is the replacement volume?

the replacement volume is 120 mL.

the bevel

the slanted portion that makes the sharp point on the end of the needle

The solute is

the solid or liquid to be dissolved or diluted. Some solutes are powdered drugs, chemical salts, and liquid nutritional supplements.

The flow rate is

the speed at which an IV will infuse a patient with fluid.

Needles are

thin stainless steel tubes that come in various lengths and diameters

Insulins are classified according

to how fast they begin to work, when they reach maximum effect, and how long their effects last: onset of action: the length of time before insulin reaches the bloodstream and begins to lower blood glucose peak of action: the time period in which the insulin is the most effective in lowering blood glucose duration of action: the period of time during which the insulin continues to lower blood glucose

the hub

which attaches to the syringe