1. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 0 Pharmacology: Principles and Applications 2 nd edition Eugenia M. Fulcher Robert M. Fulcher Cathy D. Soto Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published.

2. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 1 Chapter 10 Calculating Doses of Parenteral Medications

3. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 2 Learning Objectives  Determine the correct syringe for administration of parenteral dosages.  Calculating doses of parenteral medications in the metric system  Calculating doses of parenteral medications in units.

4. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 3 Chapter 10 Lesson 10.1

5. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 4 Parenteral Medications Given  intramuscularly  subcutaneously  intradermally  intravenously

6. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 5 Intramuscular (IM) Dosages  Absorbed quickly  Antibiotics, antihistamines, steroidal anti- inflammatory drugs, pain medications, immunizations  Syringes are calibrated in cubic centimeters (cc) or milliliters (mL)

7. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 6 Figure 10-1. 3-cc Syringe  Numbers on syringe are in ½-mL increments; start with ½ mL, end with 3 mL  Each marking between numbers represents a tenth of one mL or 0.1 mL

8. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 7 3-cc Syringe (cont’d.)  2.2 mL:

9. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 8 Typical Syringes  50-U insulin syringe (top)  3-cc syringe (middle)  Tuberculin syringe (bottom)  when dose is less than 1 cc  calibrated to 0.01 mL

10. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 9 Reading Syringes  Typically the dose would be written with a decimal instead of fraction because syringe is in the metric system (ml)  Always place a “0” in front of the decimal if no number is found  Some medications are in units per milliliter, such as penicillin or insulin

11. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 10  Typical dose volumes/syringe  Intramuscular (IM) – 0.5 – 2 mL (No more than 3 mL) – 3 mL syringe  Subcutaneous (SC) – 0.5 – 1 mL (No more than 2 mL) – insulin, tuberculin, 3 mL syringes  Intradermal (ID) – 0.1 – 0.2 mL (Never more than 0.2 mL) – tuberculin syringe Routes of Administration and Typical Dose Volumes

12. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 11 Chapter 10 Lesson 10.2

13. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 12 Ratio and Proportion Ordered: meperidine (Demerol) 100 mg every 3 to 4 hours IM for pain management. Available: meperidine 50 mg/1 mL Compare the known ratio to the unknown ratio. Known: 50 mg : 1 mL Unknown: 100 mg : x mL Administer Demerol 2 mL every 3 to 4 hours 100 mg X 1ml / 50mg =

14. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 13  Ordered: meperidine (Demerol) 100 mg q3– 4h IM for pain management  Available: 50 mg/1 mL  Are the units in the same measurement? Formula Method

15. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 14  Ordered: meperidine (Demerol) 100 mg q3– 4h IM for pain management  Available: 50 mg/1 mL  Are the units in the same measurement system?  Yes Formula Method (cont’d.)

16. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 15  Ordered: meperidine (Demerol) 100 mg q3– 4h IM for pain management  Available: 50 mg/1 mL  Are the units in the same measurement?  Yes  100 mg x 1 mL / 50mg = 2 mL Formula Method (cont’d.)

17. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 16  Ordered: meperidine (Demerol) 100 mg q3–4h IM for pain management  Available: 50 mg/1 mL  Are the units in the same measurement?  Yes  What size syringe would you choose?  3cc Formula Method (cont’d.)

18. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 17 Calculating Parenteral Drugs in Units  Most antibiotic medications in units are given in 3 mL syringes  Medications, such as heparin, of less than 1 mL are given in tuberculin syringes, except insulin  Insulin preparations are given in insulin syringes

19. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 18 Ordered: penicillin G 200,000 units IM Available: penicillin G 250,000 units/mL 20 units X 1ml / 25 units = 0.8ml Calculating Medications in Units – Ratio and Proportion

20. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 19 Ordered: penicillin G 200,000 units IM Available: penicillin G 250,000 units/mL Calculating Doses in Units – Formula Method

21. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 20 Calculating Doses in Units – Dimensional Analysis Ordered: penicillin G 200,000 units IM Available: penicillin G 250,000 units/mL

22. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 21 Tuberculin Syringe  1 mL capacity  calibrated in hundredths of mL

23. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 22 Calculating Heparin Doses in Units  Heparin – administered with tuberculin syringe Example: Dose ordered: heparin 2500 U Available medication: heparin 10,000 U/mL 10,000 U 1ml 2500 U x ml 2500 U X 1ml / 10000 = 0.25ml  Ratio/Proportion

24. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 23 Calculating Heparin Doses in Units  Formula Method  Dimensional Analysis Method

25. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 24 Insulin Syringe  Holds 1/2 mL (50 units) or 1 mL (100 units)  Use U-100 syringe for insulin administration only.

26. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 25 Measuring Insulin in Units Example: Ordered: Humulin R 22 units and Humulin N 26 units. Available: 10-mL vials of Humulin R U-100 and Humulin N U-100. How much insulin would you draw into a U-100 syringe? Humulin R 22 U and Humulin N 26 U for a total of 48 units.

27. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 26  Ordered: Humulin R 22 U and Humulin NPH 26 U  Ordered: Humulin R 22 U and Humulin NPH 26 U  Available: 10 mL vial of U-100 Humulin R and 10 mL vial of U-100 NPH  Are the units in the same measurement? Mixing Insulins

28. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 27  Ordered: Humulin R 22 U and Humulin NPH 26 U  Ordered: Humulin R 22 U and Humulin NPH 26 U  Available: 10 mL vial of U-100 Humulin R and 10 mL vial of U-100 NPH  Are the units in the same measurement?  Yes Mixing Insulins (cont’d.)

29. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 28  Ordered: Humulin R 22 U and Humulin NPH 26 U  Available: 10 mL vial of U-100 Humulin R and 10 mL vial of U-100 NPH  Are the units in the same measurement?  Yes  What is the desired dose? Mixing Insulins (cont’d.)

30. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 29  Ordered: Humulin R 22 U and Humulin NPH 26 U  Available: 10 mL vial of U-100 Humulin R and 10 mL vial of U-100 NPH  Are the units in the same measurement?  Yes  What is the desired dose?  Total amount of insulin is 48 U(22U + 26U = 48U) Mixing Insulins (cont’d.)

31. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 30 Mixing Insulins (cont’d.)  Which syringe would you choose?

32. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 31 Mixing Insulins (cont’d.)  Which syringe would you choose?  U-100 insulin syringe

33. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 32 Mixing Insulins (cont’d.)  Which syringe would you choose?  U-100 insulin syringe  How much insulin would you draw into this syringe?

34. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 33 Mixing Insulins (cont’d.)  Which syringe would you choose?  U-100 insulin syringe  How much insulin would you draw into this syringe?  Total of 48 U (22 U of Humulin R and 26 U of Humulin NPH)

35. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 34 Mixing Insulins (cont’d.)  Which syringe would you choose?  U-100 insulin syringe  How much insulin would you draw into this syringe?  Total of 48 U (22 U of Humulin R and 26 U of Humulin NPH)  What route is used?

36. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 35 Mixing Insulins (cont’d.)  Which syringe would you choose?  U-100 insulin syringe  How much insulin would you draw into this syringe?  Total of 48 U (22 U of Humulin R and 26 U of Humulin NPH)  What route is used?  Subcutaneous (sc)

37. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 36 Review  Type of syringe:  Volume capacity:  Calibration:  Typically used for:

38. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 37 Review (cont’d.)  Type of syringe:  Volume capacity:  Calibration:  Typically used for:

39. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 38 Review (cont’d.)  Type of syringe:  Volume capacity:  Calibration:  Typically used for:

40. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 39  Type of syringe:  3 cc  Volume capacity:  3 cc  Calibration:  0.1 mL and 15 ɱ /mL  Typically used for:  intramuscular or subcutaneous Review (cont’d.)

41. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 40 Review (cont’d.)  Type of syringe:  Volume capacity:  Calibration:  Typically used for:

42. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 41 Review (cont’d.)  Type of syringe:  U-100  Volume capacity:  100 units or 1 mL  Calibration:  2 units  Typically only used for:  administration of insulin