NURS 111 Math Quiz 3 Reading Medication Labels

Reading Medication Labels

Key Points To understand the components of a medication label, the nurse should review the label and note the:Medication name, which always includes a generic (official) name and, possibly, a trade (brand or proprietary) name. For similar-sounding names, such as dopamine and dobutamine, expect to see tall man lettering, as in DOPamine and DOBUTamine.Expiration date, which reflects the last date on which a patient should use a medication.Controlled substance marks, which exist only on labels for medications that have a potential for abuse or dependence.Bar code symbols, which may be part of the medication distribution and stock reordering systems.Lot/control number, which is critical if a medication is recalled. Dosage strength is the weight or amount of medication per tablet or other unit (of a solid medication) or per milliliter (of a liquid medication). The way a medication label lists the dosage strength varies with the medication form. It may be described by:Weight, such as 100 mg per tabletConcentration, such as 10 mg/mLEquivalent dosage strength, such as 125 mg/5 mL or 200,000 units/5 mL Some solution labels express the dosage strength as a ratio, such as 1:1000, or a percent, such as 2%. They may also express the dosage strength in milligrams per milliliter. Liquid medication labels also list the total volume, such as the fluid volume of a vial or ampule. Solid medication labels list the total amount, such as the number of capsules in a container. To avoid confusion, labels on single and multidose injectable products must prominently list the dosage strength per total volume, followed closely by the dosage strength per milliliter in parentheses. They must also include the total volume. The medication label identifies the form.Forms include tablets, capsules, liquids, powders, granules, solutions, suppositories, ointments, and patches.Common special forms include controlled release (CR), double strength (DS), enteric coated (EC), extended release (ER) extra strength (ES), long acting (LA or XL), and sustained release (SR). The medication label also specifies the administration route (how the medication should be administered).Administration routes include oral, enteral, sublingual, intravenous (IV), intramuscular (IM), subcutaneous (subcut), optical, and topical routes.Always give tablets, capsules, and caplets orally unless specified differently. For such oral forms, the label may not directly state the route, but should provide route information if a tablet or capsule must not be swallowed.

Liquids

Liquids are a frequently ordered form of medication. A liquid is a medication form that can be swallowed, instilled into the eye or ear, or given by another route, which the label must specify. A medication that is administered by mouth may be flavored, especially for pediatric patients

Dosage Labels on Injectable Liquids

Medication errors have resulted from misinterpreting the dosage strength and total volume on labels. Since 2009, the FDA has required manufacturers to prominently express the dosage strength per total volume on single and multidose injectable product labels, followed closely by the dosage strength per milliliter enclosed in parentheses. The clindamycin label illustrates these components as well as the total volume.

The label contains all the information the nurse needs to complete dosage calculations. The information on the medication label includes:

Medication name Expiration date Drug schedule (for controlled substance) Manufacturing information Total dosage found in the package Total volume or total amount in the container Form of medication Administration route Warnings Storage requirements National Drug Code (NDC) number

Other Liquid Drug Routes

Medications in liquid form may be given orally, by injection, or via inhalation by using a nebulizer. Liquid medication labels (such as meperidine injection) must indicate IM, IV, subcut, or another appropriate route of drug administration.

Routes of Administration

Oral (by mouth) Enteral (into the GI tract through a tube) within the small intestine, or via the small intestine. Sublingual (under the tongue) Injection (or parenteral), such as by the intravenous (IV)pertaining to the inside of a vein, as of a thrombus or an injection, infusion, or catheter...intramuscular (IM)pertaining to the interior of muscle tissue...or subcutaneous (subcut/SQ) route is beneath the skin Optical (administered in the eyes) Topical (administered on the skin)

tall man lettering

Practice of writing part of a drugs name in upper case letters to help distinguish drugs that sound and look alike - to avoid errors - only for portion of drug name that are similar -buPROPion and busPIRone

Place the controlled substance markings found on drug labels in order, from highest abuse potential to lowest abuse potential.

Schedule I Schedule II Schedule III Schedule IV Schedule V

Other Solid Drug Route

Some medication forms—such as tablets, capsules, and liquids—are not always administered orally. The nurse should read the label carefully because it indicates any variation from oral administration. For example: Tablets (such as Nitrostat) may be given sublingually. Otic suspensions may be used in the ears. Some capsules go in an inhaler so that the drug can be inhaled rather than swallowed.

trade name

-The trade name (brand or proprietary name) appears before the generic name and is the manufacturer's own name for the medication. -The trade or brand name is capitalized and usually very noticeable on the label, helping the manufacturer market the medication. -Only the company that manufactures the named trade medication can use its brand name, followed by a ® (registration symbol) or a TM (trademark symbol), indicating the manufacturer has registered the name with the U.S. Patent and Trademark Office.

What is the dose strength per total volume for this vial of bumetanide?

1 mg/4 mL see photo on phone 1 mg/4 mL The medication label indicates that there is 1 mg of bumetanide in 4 mL of solution, which is the total volume in the vial. 1 mg/1 mL The medication label does not indicate that there is 1 mg of bumetanide in 1 mL of solution. 0.25 mg/4 mL The medication label does not indicate that there is 0.25 mg of bumetanide in 4 mL of solution. 0.25 mg /1 mL While the medication label does support that there is 0.25 mg of bumetanide in 1 mL of solution, this is not the strength per the total volume of the vial, which is 4 mL.

Which is the concentration for amoxicillin on the medication label?

200 mg/5 m see photo of label on phone

Reading Medication Labels / Medication Label: Dosage Strength

Another critical component of the medication label is the dosage strength, which is the weight or amount of medication (measured in units of volume or concentration), such as the weight (in milligrams) per tablet or per milliliter. For solid medications, the dosage strength is the amount of medication per tablet, capsule, or powders. For liquid medications, it is the amount of medication in a specific amount of solution. Different systems of measure can be used to express a medication's dosage strength. For example: Some labels state the dosage strength in metric and apothecary measures, such as the label for nitroglycerin. Some labels for oral liquids may list household measures, such as "Each 15 mL (one tablespoon) contains 80 mg."

Example Dosage Strengths

Because medication forms vary, the way their dosage strength is expressed varies, too. As the examples show, it may be described by: Weight Concentration Equivalent dosage strength

Additional Information on Drug Labels

Besides the medication's name, dosage strength, and form, medication labels contain additional information that the nurse should note, including the: Expiration date Controlled substance marks, which only appear on labels for medications that are controlled substances Bar code symbols Lot/control number

Which are the identifiers for a medication's trade name on a drug label? Italicized Trade names are not italicized on a drug label, so this is not an identifier. Capitalized Trade names are capitalized on a drug label, so this is an identifier. Underlined Trade names are not underlined on a drug label, so this is not an identifier. Registered ( ®) Trade names may be followed by a registration symbol on a drug label, so this is an identifier. Trademark (™) Trade names may be followed by a TM symbol on a drug label, so this is an identifier.

Capitalized Trade names are capitalized on a drug label, so this is an identifier. Registered ( ®) Trade names may be followed by a registration symbol on a drug label, so this is an identifier. Trademark (™) Trade names may be followed by a TM symbol on a drug label, so this is an identifier.

Controlled substances

Controlled substances are medications that are classified into schedules and ranked by their potential for abuse and physical and psychological dependence. The rankings range from Schedule I to Schedule V. Medications with the highest abuse potential are Schedule I, and those with the lowest or limited abuse potential are Schedule V. Schedule I drugs have no medicinal use.

Where will the generic name of a medication appear on a drug label? Directly under the brand name Directly above the brand name Immediately after the brand name Immediately before the brand name

Directly under the brand name The generic name of the medication will be listed directly under the brand name on the drug label.

Tall Man Letters Drug Names http://www.ismp.org/

Drug Name with Tall Man Letters Confused With acetaZOLAMIDE acetoHEXAMIDE acetoHEXAMIDE AcetaZOLAMIDE buPROPion busPIRone busPIRone buPROPion chlorproMAZINE chlorproPAMIDE chlorproPAMIDE chlorproMAZINE clomiPHENE clomiPRAMINE clomiPRAMINE clomiPHENE cycloSERINE cycloSPORINE cycloSPORINE cycloSERINE DAUNOrubicin DOXOrubicin dimenhyDRINATE diphenhydrAMINE diphenhydrAMINE dimenhyDRINATE DOBUTamine DOPamine DOPamine DOBUTamine DOXOrubicin DAUNOrubicin glipiZIDE glyBURIDE glyBURIDE glipiZIDE hydrALAZINE hydrOXYzine hydrOXYzine hydrALAZINE medroxyPROGESTERone methylPREDNISolone - methyTESTOSTERone methylPREDNISolone medroxyPROGESTERone - methyTESTOSTERone methyTESTOSTERone medroxyPROGESTERone - methylPREDNISolone niCARdipine NIFEdipine NIFEdipine niCARdipine prednisoLONE predniSONE predniSONE prednisoLONE sulfADIAZINE sulfiSOXAZOLE sulfiSOXAZOLE sulfADIAZINE TOLAZamide TOLBUTamide TOLBUTamide TOLAZamide vinBLAStine vinCRIStine vinCRIStine vinBLAStine

For liquid medications:

For liquid medications, it is the amount of medication in a specific amount of solution.

For solid medications:

For solid medications, the dosage strength is the amount of medication per tablet, capsule, or powders.

Dosage Strength as a Ratio or Percent

For some solutions, the medication label expresses the dosage strength as a ratio or percent. They may also express the dosage strength in milligrams per milliliter. Select each medication label to learn more. epinephrine (purple square label photo) Epinephrine injection label The dosage strength appears as a ratio (1:1000). The dosage strength also appears in milligrams per milliliters, as 1 mg/mL. Lidocaine hydrochloride injection label (blue pic on phone after epinephrine) The dosage strength appears as a percent (1%). The dosage strength also appears in milligrams per milliliters, as 10 mg/mL.

Granules

Granules are small particles or grains. Unlike powders, granules usually flow freely. They may be mixed in food and swallowed or mixed with a liquid and swallowed or injected, as instructed. (Note: Some smaller-diameter tubes shouldnothave granules administered through them, as they will clog.)

Medication Label: Dosage Strength Key Points

Key Points Dosage strength is the weight or amount of medication per tablet or other unit (of a solid medication) or per milliliter (of a liquid medication). The way a medication label lists the dosage strength varies with the medication form. It may be described by:Weight, such as 100 mg per tabletConcentration, such as 10 mg/mLEquivalent dosage strength, such as 125 mg/5 mL or 200,000 units/5 mL Some solution labels express the dosage strength as a ratio, such as 1:1000, or a percent, such as 2%. They may also express the dosage strength in milligrams per milliliter. Liquid medication labels also list the total volume, such as the fluid volume of a vial or ampule. Solid medication labels list the total amount, such as the number of capsules in a container. To avoid confusion, labels on single and multidose injectable products must prominently list the dosage strength per total volume, followed closely by the dosage strength per milliliter in parentheses. They must also include the total volume.

Medication Label: Form and Route Key Points

Key Points The medication label identifies the form.Forms include tablets, capsules, liquids, powders, granules, solutions, suppositories, ointments, and patches.Common special forms include controlled release (CR), double strength (DS), enteric coated (EC), extended release (ER) extra strength (ES), long acting (LA or XL), and sustained release (SR). The medication label also specifies the administration route (how the medication should be administered).Administration routes include oral, enteral, sublingual, intravenous (IV), intramuscular (IM), subcutaneous (subcut), optical, and topical routes.Always give tablets, capsules, and caplets orally unless specified differently. For such oral forms, the label may not directly state the route, but should provide route information if a tablet or capsule must not be swallowed.

Drug Name Confusion

Some medications have similar-sounding names. However, they may have different actions and chemical structures. Consider the antidepressant bupropion (Wellbutrin) and the anti-anxiety drug buspirone (BuSpar). Although their generic names are similar, the medications differ greatly in their actions, composition, and uses. To help avoid confusion between similarly-named medications, the Food and Drug Administration (FDA) requires the use of Tall Man Lettering letters in generic names associated with errors. The tall man style uses capital and lowercase letters and bold type in a way that highlights the differences between the medication names. For example, the confusingly similar medications bupropion and buspirone would appear as buPROPion and busPIRone in tall man letters. The look-alike medication names in this table are modified with tall man (mixed case) letters to highlight the dissimilarities in their names. Studies show that highlighting parts of medication names with tall man letters helps health care professionals distinguish between similar names, making the drugs less likely to be mistaken for each other. Safety-conscious organizations, such as The Joint Commission, FDA, and Institute for Safe Medication Practices (ISMP), recommend using tall man letters to reduce confusion. Tall-man lettering can be implemented in hospitals by computer-generated labels placed on unit doses of drugs commonly confused for one another. This decreases the risk for the nurse administering the wrong drug to the patient. The table lists FDA-approved generic drug names with tall man letters.

Special Forms of Solid and Liquid Medications

Special forms of medications exist, often to control absorption rate and location. If the medication has a special form, its label includes that information too, using words or abbreviations to describe it. Common special forms include CR - controlled release DS - double strength EC - enteric coated ES - extra strength ER - extended release LA - long acting SR - sustained release XL - long acting

Special Forms of Solid and Liquid Medications

Special forms of medications exist, often to control absorption rate and location. If the medication has a special form, its label includes that information too, using words or abbreviations to describe it. Common special forms include: CR - controlled release DS - double strength EC - enteric coated ES - extra strength ER - extended release LA - long acting SR - sustained release XL - long acting The nurse should always read medication labels carefully. Some medication form abbreviations indicate that the medication was made for extended action, or slow release, of its active ingredient. These medications typically are administered fewer times a day. Some examples include Calan SR, Inderal LA, and Procardia XL. For these special forms, the nurse should NEVER crush them and make sure that the patient swallows them whole, as they will become immediate release and absorb in the stomach resulting in a drastic medication error.

Reading Medication Labels / Summary

Summary A medication label has specific components, which the nurse should review closely to help ensure safe medication administration. First, the nurse should note the medication name (generic and trade, if provided), expiration date, any controlled substance marks (if the medication has a potential for abuse or dependence), bar code symbols, and lot/control number. The nurse should pay attention to the dosage strength, which varies with the medication form and may be described by weight, concentration, or equivalent dosage strength. For some solutions, the dosage strength is listed as a ratio or a percent. Liquid medications also list the total volume (such as a vial's fluid volume), but solid medications list the total amount (such as the number of tablets in a container). In addition to the total volume, labels on single and multidose injectable products must prominently list the dosage strength per total volume and, in parentheses, the dosage strength per milliliter. The nurse should also check the medication form, which may be tablets, capsules, liquids, powders, granules, solutions, suppositories, ointments, or patches, and note any special form, such as controlled release (CR), double strength (DS), enteric coated (EC), extra strength (ES), long acting (LA or XL), and sustained release (SR). Finally, the nurse should look for the administration route, which may be oral, enteral, sublingual, intravenous, intramuscular, subcutaneous, optical, or topical. For oral forms, such as tablets or capsules, the label may not directly state the route. It must specify the route if the medication should not be swallowed.

Suppositories

Suppositories are a semisolid form of medication. A suppository is a medication form that melts easily when inserted into the rectum, vagina, or urethra, as directed.

Forms of medication

Tablets Capsules Liquids Powders or granules Solutions, such as oral suspensions and aqueous solutions, which are indicated by milliliters (mL) Suppositories Ointments Patches

Tablets

Tablets are a common, small, solid form of medication. It may be almost any size, shape, or color. Most tablets are designed to be swallowed whole.

Coated Particles

The Depakote Sprinkle label identifies this special form as coated particles in capsules. Unlike other forms of divalproex sodium, this form "may be swallowed whole or opened and contents placed on food" as noted on the label

Delayed Release

The ERY-TAB label identifies this special form as delayed-release, enteric coated tablets. Because the tablets are enteric coated, they should not be crushed.

Long Acting

The Inderal LA label identifies this special form as long-acting capsules. In this formulation, the medication may be given once a day rather than two or more times a day for the standard form.

By Concentration Namenda mematine HCL oral solution 2mg/mL 12 fl oz (360 mL)

The Namenda label lists dosage strength per milliliter. On the Namenda label, the dosage strength is 2 mg per mL, which means that the oral solution Namenda contains 2 mg of medication in each milliliter of liquid.

By Weight: Tricor (R) Fenofibrate Tablets 48mg 90 Tablets

The TriCor label lists dosage strength per tablet On the TriCor label, the dosage strength is 48 mg per tablet. In other words, this is the weight and unit of measurement for the medication in each tablet.

Equivalent Dosage Strengths 100 mL (in red above everything) Equivalent to 125 mg (200,000 units) per 5 mL when reconstituted according to directions. VEETIDS (R) Penicillin V Potassium For Oral Solution, USP

The Veetids label lists dosage strength in two ways. The Veetids label shows two different, yet equivalent, dosage strengths: 125 mg per 5 mL 200,000 units per 5 mL The prescriber may order the oral solution in either unit of measurement.

Extended Release

The dextromethorphan polistirex label identifies this special form as an extended-release oral suspension. It may be administered once or twice a day instead of three or four times a day for the standard form of this medication.

Expiration Date

The expiration date (sometimes abbreviated Exp) reflects the last date on which a patient should use a medication. Usually, the date appears on the back or side of a label and is printed as the month/year. Medications that must be reconstituted supply specific expiration instructions. For example, a label may read, "Discard unused portion of reconstituted suspension after 14 days." The nurse should always check the medication's expiration date and, when in a hospital, return expired medications to the pharmacy.

administering the wrong form is a medication erro

The medication label identifies the form, which tells the nurse the type of preparation in the package. This is critical information because even if a patient receives the correct medication, administering the wrong form is a medication error.

Why are the bar codes located on medication labels useful in the clinical environment? They prevent medication errors. The bar code may be part of a system used to prevent medication errors, but it is not designed to prevent errors by itself. They identify the drug in the medication distribution system. Each medication has an individual bar code that is used to identify it in the medication distribution system. They identify the patient for whom the medication should be administered. The bar code identifies the medication, not the patient to whom it should be administered. They allow for the automatic re-ordering of a medication once administered to a patent. The bar code may make ordering easier, but the medication is not automatically re-ordered after medication administration.

They identify the drug in the medication distribution system. Each medication has an individual bar code that is used to identify it in the medication distribution system.

How many times should a nurse read a medication label?

Three times

General Information on a Medication Label Key Points

To understand the components of a medication label, the nurse should review the label and note the: -Medication name, which always includes a generic (official) name and, possibly, a trade (brand or proprietary) name. For similar-sounding names, such as dopamine and dobutamine, expect to see tall man lettering, as in DOPamine and DOBUTamine. -Expiration date, which reflects the last date on which a patient should use a medication. -Controlled substance marks, which exist only on labels for medications that have a potential for abuse or dependence. -Bar code symbols, which may be part of the medication distribution and stock reordering systems. -Lot/control number, which is critical if a medication is recalled.

Total Volume and Total Amount in Container

Total Volume and Total Amount in Container For liquid medications, the label lists the total volume (the quantity contained in a bottle, vial, or ampule). For solid medications, the label lists the total amount in the container. For both medication forms, the dosage strength also appears on the label. Namenda (see photo) Namenda oral solution label Labels on solutions for injections or oral liquids list the total volume. For liquids, total volume refers to the total fluid volume. On the Namenda oral solution label, the total volume is 12 fl oz (360 mL). The label also states that the dose strength is 2 mg/mL. Isentress (see photo) Isentress tablets label Labels on solid medication forms, such as tablets or capsules, list the total amount as the total number of tablets or capsules in the container. On the Isentress label, the total number in the container is 60 tablets. The label also states that the dosage strength is 400 mg per tablet.

suspension

a liquid in which small particles of a solid are dispersed, but not dissolved, and in which the dispersal is maintained by stirring or shaking the mixture

solution

a mixture of one or more substances dissolved in another substance. The molecules of each of the substances disperse homogenously and do not change chemically. A solution may be a gas, a liquid, or a solid.

solution a mixture of one or more substances dissolved in another substance. The molecules of each of the substances disperse homogenously and do not change chemically. A solution may be a gas, a liquid, or a solid.

a mixture of one or more substances dissolved in another substance. The molecules of each of the substances disperse homogenously and do not change chemically. A solution may be a gas, a liquid, or a solid.

ointment

a semisolid, externally applied preparation, usually containing a drug. Various ointments are used as local analgesic, anesthetic, antibiotic, astringent, depigmenting, irritant, and keratolytic agents

capsule

a small soluble container, usually made of gelatin, used for enclosing a dose of medication for swallowing.

controlled substance

any drug defined in the five categories of the federal Controlled Substances Act of 1970. The categories, or schedules, cover opium and its derivatives, hallucinogens, depressants, and stimulants. Schedule I drugs have a high abuse potential and no approved medical uses. Drugs in Schedules II to V all have approved medical indications, with decreasing abuse and dependence liabilities as the schedule number increases.

On the medication label, the unit dose for each acarbose tablet is 25 mg.

see drug label on photo in phone

Dosage Labels on Injectable Liquids

see pictures Dosage Strength per Total Volume The dosage strength for the entire vial (total volume) is prominently displayed as 600 mg/4 mL. Total Volume The vial size (total volume) is 4 mL in this single-dose vial of clindamycin injection. Dosage Strength per Milliliter The dosage strength per milliliter is 150 mg/mL, which appears in parentheses.

generic name

the official established nonproprietary name assigned to a drug. A drug is licensed under its generic name, and all manufacturers of the drug list it by its generic name. Legally, all medication labels must include the generic name, which is supplied by the manufacturer who developed the medication. Each medication has only one generic name. If it also has a trade name, the generic name must appear right below it (sometimes in parentheses). Medications that have been in use for many years may not include a trade name or brand name, such as morphine and codeine. Some may list only the generic name or the trade and generic names, such as Lasix (furosemide).