2. © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 10 Interpreting Medication Labels and Package Inserts PowerPoint ® Presentation to accompany: Math and Dosage Calculations for Healthcare Professionals Fourth Edition Booth, Whaley, Sienkiewicz, and Palmunen

3. 10-2 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. 10.1 Differentiate information on a medication label and within a package insert. 10.2 Distinguish information related to administration routes for medications. Learning Outcomes

4. 10-3 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Key Terms  Bar code  Dosage strength  Generic name  ID – intradermal  IM - intramuscular  IV- Intravenous

5. 10-4 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Key Terms (cont.)  Package insert  Reconstitute  Subcut – subcutaneous  Trade name  Transdermal

6. 10-5 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Introduction  The drug label and package inserts contain information needed to perform dosage calculations.  Read the label carefully.

7. 10-6 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Information on Medication Label and Package Insert  Drug name  Form of the drug  Dosage strength  Total amount in the container  Warnings  Route of administration  Storage requirements  Manufacturing information

8. 10-7 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Drug Name  Generic Name Official name Used for national listings  United States Pharmacopeia (USP)  National Formulary (NF) Levothyroxine Sodium (generic name)

9. 10-8 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Drug Name (cont.)  Trade Name Brand name Used to market the drug Property of drug company – Registered mark ® Synthroid  (trade name)

10. 10-9 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Drug Name (cont.) Rule 10-1 You must know both the generic and trade names of drugs. Example Vicodin ® is a narcotic painkiller. Generic name: hydrocodone bitartrate and acetaminophen Other trade names: Anexsia ®, Lortab ®, Zydone ®

11. 10-10 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Form of the Drugs  Solid oral medications Tablets, capsules, gelcaps, caplets  Liquids Oral, injections, inhalants, drops, sprays, mists  Other Ointments, creams, lotions, patches, suppositories, shampoos

12. 10-11 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Dosage Strength  Dosage strength is the amount of drug present per dosage unit or form of the drug.  Labels include information about the amount of drug present.

13. 10-12 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Dosage Strength (cont.)  Solid medications The dosage strength is the amount of drug present per tablet, capsule, or other form. Dosage strength 2.5mg/1 tab

14. 10-13 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Dosage Strength (cont.)  Liquid medications The dosage strength is the a mount of drug present in a quantity of solution. Medications are manufactured with dosage strengths that match commonly prescribed doses.

15. 10-14 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Combination Drugs  If available, the trade name may be used to order combination drugs.  Generic names and dosage strengths of all components must appear on the label.

16. 10-15 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Total Number or Volume in Container  Many meds are packaged in unit doses.

17. 10-16 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Total Number or Volume in Container  Multiple-dose containers Prescription medications Non-prescription medications

18. 10-17 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Total Number or Volume (cont.) Rule 10-2 Do not confuse the total amount of drug in the container with the dosage strength.

19. 10-18 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Total Number or Volume (cont.) Example This container holds 100 tablets, and each tablet has a dosage strength of 5 mg per tablet.

20. 10-19 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Route of Administration  Directions may be on the label Tablets, capsules, gelcaps, caplets  Swallowable  Sublingual  Chewable Liquid medications  Oral  Injectable Inhalants Topical / transdermal medications

21. 10-20 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Error Alert! Read the label carefully! Do not administer drugs by any route other than as described in the drug label or on the order.

22. 10-21 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Warnings  Warnings help to administer drugs safely.  There are many types of warnings. Dispensing recommendations For specific groups, i.e. children, pregnant women For controlled substances About combining with other drugs or products

23. 10-22 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Warnings (cont.)

24. 10-23 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Warnings (cont.)  Disposal – follow facility guidelines

25. 10-24 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Storage Information  Proper storage helps maintain the drug’s potency and effectiveness.  Storage information on the label may include directions about: storage temperature; exposure to light; length of time the drug will remain potent after the container has been opened or reconstituted.

26. 10-25 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Storage Information (cont.)

27. 10-26 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Manufacturing Information  Labels Regulated by the U.S. Food and Drug Administration (FDA) Must include:  Name of the manufacturer  Expiration date (EXP)  Lot number  Bar codes

28. 10-27 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Manufacturing Information (cont.)

29. 10-28 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Manufacturing Information (cont.) Rule 10-3 Never use a drug after the expiration date has passed. Older drugs may become chemically unstable or altered. Patients should be educated to check expiration dates.

30. 10-29 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Information About Reconstituting Drugs  Powder forms must be reconstituted.  Other drugs require dilution.

31. 10-30 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Information About Reconstituting Drugs (cont.)  Directions for reconstituting or diluting are on the label. These include: type and amount of diluent; solution strength once reconstituted; time period for safe administration.

32. 10-31 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Information About Reconstituting Drugs (cont.)

33. 10-32 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Error Alert! Consider the age and health needs of the patient when administering a drug.

34. 10-33 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Package Inserts  Provide complete and authoritative information about a medication  Include a number of sections Description -- chemical and physical Clinical Pharmacology -- actions of the drug Indications and Usage

35. 10-34 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Package Inserts (cont.) Contraindications Warnings – serious side effects Precautions Adverse Reactions – anticipated side effects

36. 10-35 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Package Inserts (cont.) Overdosage Dosage and Administration Preparation for Administration Manufacturer Supply

37. 10-36 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Practice What is the generic name of the drug? At 25°C (77°F) excursions permitted to 15-30°C (59-86°F) 50 mg/1 capsule What is the dosage strength? How should this drug be stored? celecoxib

38. 10-37 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Label Information Related to Medication Routes  Labels include unique information related to administration route.  Read labels carefully when: calculating doses; administering medications; dispensing medications.

39. 10-38 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Oral Medications Oral medications come in solid or liquid forms.  Tablets Scored Chewable Enteric-coated

40. 10-39 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Oral Medications  Capsules A gelatin shell holds the drug. Some should be swallowed whole. Others may be opened and mixed with food.  Controlled-release medications Usually swallowed whole

41. 10-40 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Oral Drugs (cont.) Rule 10-4 Tablets may be broken to give a partial dose only when the tablets are scored. Never crush or break  Enteric-coated medications  Controlled-release medications (CR)  Extended-release medications (ER or XL)  Sustained-release medications (SR)

42. 10-41 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Oral Medications (cont.)  Liquids Oral solutions Syrups Elixirs Oral suspensions Liquids Dosage strength corresponds to a specific volume of the solution – 500 mg / 10 mL

43. 10-42 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Oral Medications (cont.) Rule 10-5 When reconstituting a drug, you must write your initials and the time and date of reconstitution on the label. shf 7/21/08 @ 1400

44. 10-43 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Oral Medications (cont.)  Measured by Droppers Calibrated spoons Medicine cups Oral syringes

45. 10-44 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Patient Education  Check for language barriers.  Make sure patient/caregiver can read and understand the label.  Check for drug allergies.  Review dose, frequency, and length of time drug is to be taken.

46. 10-45 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Patient Education  Review special instructions.  Describe adverse effects.  Refer to label as needed.

47. 10-46 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Practice Skelaxin ® 1 tablet tid What is the trade name of the drug? What is the usual dosage? What is the dosage strength? 800 mg/1 tablet

48. 10-47 © 2012 The McGraw-Hill Companies, Inc. All rights reserved.  Packaged as Single-use ampules or vials Single-use prefilled syringes Multi-use vials  Small containers have small labels Limited space Some information printed on package insert Parenteral Medications

49. 10-48 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Parenteral Drugs (cont.)  Routes Intradermal (ID) Intramuscular (IM) Intravenous (IV) Subcutaneous (Subcut) Inhalant Transdermal

50. 10-49 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Parenteral Medications (cont.)  Dosage strength is the amount of drug per dosage unit.

51. 10-50 © 2012 The McGraw-Hill Companies, Inc. All rights reserved.  Insulin labels Origin of insulin Onset of action Parenteral Medications (cont.)

52. 10-51 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Practice 20 mg/2 mL Furosemide What is the dosage strength of the drug? What is the drug’s name? What is the route of administration? IM or IV

53. 10-52 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Medications Administered by Other Routes  Sublingual (under the tongue)  Buccal (between the tongue and cheek)  Rectal  Vaginal  Topical  Otic or Ophthalmic  Transdermal  Inhalant

54. 10-53 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Drugs Administered by Other Routes (cont.)  Dosage strength varies with type of drug and how it is administered.

55. 10-54 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. In Summary  In this chapter you learned to differentiate information on a drug label and on a package insert.

56. 10-55 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. In Summary (cont.) distinguish administration routes for medications.

57. 10-56 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Apply Your Knowledge 1. What is another name for the brand name? 2. What is the official name of a drug? ANSWER: trade name ANSWER: generic name

58. 10-57 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Apply Your Knowledge True or False Enteric-coated tablets can be crushed and mixed with food. All capsules may be opened and mixed with food. Parenteral forms of drugs include transdermal and inhalant drugs. T F F This would allow the drug to be absorbed sooner than intended. Some capsules should be swallowed whole.

59. 10-58 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Apply Your Knowledge True or False (cont.) The warnings section of a package insert lists the more serious, possibly fatal, side effects of a drug. You may administer a drug after the expiration date has expired if you do not have any new ones. T F It may not provide correct dosage strength or may have an effect different than intended.

60. 10-59 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. Apply Your Knowledge True or False (cont.) You can use as much solution as you need to reconstitute a powdered medication. The amount of drug in a container is not the same as the dosage strength. F You must follow the directions for reconstituting a drug that are on the label or in the package insert. T

61. 10-60 © 2012 The McGraw-Hill Companies, Inc. All rights reserved. End of Chapter 10 Read in order to live. -Henry Fielding