Oral Medications

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Nichole Weaver
MSN/Ed,RN,CCRN
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Included In This Lesson

Study Tools For Oral Medications

Pharm Math Equations (Cheatsheet)
Medication Math Cheatsheet (Cheatsheet)
MedMath Mind Map (Cheatsheet)
Med Math Practice Problems (Cheatsheet)
140 Must Know Meds (Book)

Outline

Overview

  1. Key points for oral medications
    1. Tablets – whole or half (if scored)
      1. CAN’T cut ER, EC, etc.
    2. Capsules – whole only
    3. Liquid solutions – in mL or tsp/tbsp
      1. Peds – may be weight-based
    4. Appropriate?
      1. Can this med be cut in half?
      2. Is it within the appropriate dose range?
      3. If the wrong form – call pharmacy
  2. Think “tabs per dose”, “caps per dose”, “mL per dose” etc.

Nursing Points

 

Examples

  1. Order: Furosemide 60 mg PO q8h. Available: Furosemide 20 mg scored tabs. How many tabs per dose?
  2. Order: Diltiazem 2.5 mg PO q12h. Available: Diltiazem 5 mg scored tabs. How many tabs per dose?
  3. Order: Gabapentin 600 mg PO daily. Available: Gabapentin 300 mg tabs. How many tabs per dose?
  4. Order: Ibuprofen 100 mg PO once. Available: Ibuprofen 20 mg/mL suspension. How many tsp per dose?
  5. Order: Azulfidine 1.5 g PO daily. Available: Azulfidine 500 mg capsules. How many caps per dose?

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Transcript

All right, in this lesson we’re going to look through some practice problems for oral medications. I’m gonna use some of the formula as well as some in dimensional analysis because I want you to see both ways worked out.

But first I wanna give you some key points about oral medications that you need to be thinking about, not only when you’re answering questions, but also when you’re doing dosage calculation. If you’re dealing with tablets, remember it could be a whole tablet or a half tablet if it’s scored. But remember that extended release, enteric coated tablets, none of those can be cut.
So if the question says, “How many tablets would this be, is this an appropriate dose?” and it’s one and a half tablets but it’s an extended release, then the answer becomes no because you can’t cut it in half. So keep that in mind.

Capsules, whole capsules only. Liquids might be milliliters, might be teaspoons or tablespoons, make sure you know your conversions, and remember, some of this might be weight-based as well, so make sure you’re thinking about that.

Even with oral medications, you always wanna think, “Is this appropriate?” Again, am I allowed to cut this medication? Does it fit within a dose range? If I need it cut but I can’t, do I need to call a pharmacy because it’s the wrong form? Just things to think about.

And then any time we’re doing these medications, you’re always gonna think per dose, so tabs per dose, milliliters per dose, etc. All right, let’s work some out.

Example number one. The order is for furosemide 60 milligrams, PO q8h. Available is furosemide 20 mg scored tabs. How many tabs per dose?

Let’s start with the dosage formula. Dosage formula says what we want, so that would be 60, over what we have, 20, times what it’s in, one tab. And that gives us, 60 divided by 20, three tabs. Now I wanna show you this in dimensional analysis as well, because remember dimensional analysis can be used for even the most simple problems.

Start with what we’re looking for. We want to find tabs per dose. Transfer your units over. Tabs, one tab is 20 milligrams. Transfer your units up. What do we know? Sixty milligrams per dose, cancel, cancel, tabs per dose, one times 60 divided by 20 divided by one equals three tabs. Same thing, but two different ways to get there, it’s completely up to you on how you wanna do it.
All right, example number two. Diltiazem, 2.5 milligrams, PO q12h. Available is diltiazem five milligrams, scored tabs. How many tabs per dose?

So let’s say what we want over what we have, want, have. Times what it’s in, one tablet, this is what’s available. Two and a half divided by five, 0.5 tabs. Let’s look at dimensional analysis and do the same thing.

We’re looking for tabs per dose. Transfer your top units over, tabs. What do we know? One tab is five milligrams. Transfer your units. What do we know about milligrams? We’re looking for two and a half milligrams per dose. Multiply across the top, divide across the bottom. One times two and a half divided by five divided by one equals 0.5 tabs. Again, your last step is always to verify. Does a half tab of this medication make sense? It’s a scored tab, that seems appropriate, so we would verify, yes this makes sense.
Okay, example number three. Gabapentin 600 milligrams, PO daily. Available is gabapentin 300 milligram tabs. How many tabs per dose?

Now, one thing I would caution you against is some people will look at this and they’ll automatically know the answer because they do math in their head. And that’s fine, but I always encourage you to use a formula or use dimensional analysis as a double check. It’s very possible that you could accidentally flip these. You see this and you go, “Oh, it’s a half a tab,” but you actually got it backwards. So make sure that you’re using your formulas. Let’s do this one more time.

What we want over what we have times what it’s in, which is one tab. Six hundred divided by 300 is two tabs. Make sense? Yes. If you had gone too quickly you could have said half a tab, and you would have been wrong.

Now let’s do dimensional analysis just for the sake of showing you. What we’re looking for is tabs per dose. Transfer your top units over. What do we know? One tab is 300 milligrams. Transfer your units up. What else do we know about milligrams? Six hundred milligrams in one dose. Multiply across the top, divide across the bottom. One times 600 divided by 300 divided by one gets you two tabs. All right.

Great, example number four. Ibuprofen 100 milligrams, PO one time. Available, Ibuprofen 20 milligrams per mL suspension. How many teaspoons per dose?

Okay, so identify, convert, solve, and verify. We’re identifying, what are we looking for? We’re looking for teaspoons. Do we have teaspoons? No, we have milliliters. In this case, it may be easier to find your milliliters and then convert, but you can do it either way you want. I’m actually going to convert after I solve.

So, what I want, 100 milligrams, over what I have, 20 milligrams, times what it’s in, one milliliter. One hundred divided by 20 gets me five, that leaves me with five milliliters. Then you have to convert this to teaspoons. How many teaspoons is five milliliters? One teaspoon. So this is your verify step, are you in the right units? I see this a lot, people get to this part and they forget to convert back to teaspoons at the end, so part of verify is are you in the right units.

I wanna show you this in dimensional analysis because one of the benefits of dimensional analysis is not having to do separate conversions. So let’s look at it this way.

What are we looking for? Teaspoons per dose. Transfer our top units over, teaspoons. Do we know anything about teaspoons here? Nope. So let’s convert. One teaspoon is how many milliliters? Five. Now transfer our milliliters over. What do we know about milliliters? One milliliter is 20 milligrams. Transfer units over. What do we know about milligrams? We want 100 milligrams in one dose. Multiply across the top, one times one times 100. Divide across the bottom, divided by five, divided by 20, divided by one. Gets us one teaspoon per dose. Again, cancel milligrams, cancel milliliters, you can see you’re left with what you’re looking for.

Let’s do one more. Azulfidine 1.5 grams PO daily. Available is 500 milligram capsules. How many caps per dose? So again, identify, convert, solve, and verify. Identify: we are looking for capsules per dose. We’ve got grams here, we’ve got milligrams here. So we’re kind of aware something’s going on. Convert: I need both of these to be in grams or in milligrams. It’s completely up to you what you choose to do. Personally, I’m gonna put everything into the unit of the actual order, because I feel like that makes more sense.

So instead of 500 milligrams we’re gonna say that these capsules are 0.5 grams. Move over three spaces, 0.5 grams. Now I can work on solving, I’m gonna use my dosage formula. What do I want, 1.5 grams. What do I have, 0.5 grams in one capsule. 1.5 divided by .5 gets us three. Now, if you had chosen to do this the other way you could have also said that this was 1500 milligrams, therefore you would have said 1500 milligrams over 500 milligrams, what I want over what I have, times what it’s in, and you would’ve gotten the same answer, three capsules.

Now, let’s see what this looks like in dimensional analysis, again, not having to do separate conversion, it takes one step out of the process. I’m looking for caps per dose. Transfer my units over. What do I know about capsules? I know that one capsule is 500 milligrams. Do I know anything else about milligrams? Nope, so I have to convert. A thousand milligrams going to grams is one gram. What do I know about grams? Transfer the units. I know that I want 1.5 grams per dose. Cancel, cancel. I’m left with caps per dose, and I’m good to go. One thousand times 1.5 divided by five gives us three capsules.

Okay? So either way works. Again, I want you guys to just find the process that works for you, go back and review these. We’ve provided these without answers in the outline if you want to review them again and do them yourselves. The more you can practice, the better you’ll get at them.

We love you guys, make sure you’re continuing to work on these dosage calculations. Now go out and be your best selves today, and as always, happy nursing!

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Pharmacology for Nursing (MedMaster)

The Pharmacology Course is a one-stop-shop for all things medication related! We’ll talk you through how to be successful in pharmacology and how to be safe when administering meds. We break down the most common and most important medication classes into easy-to-understand sections. We even walk you through how to conquer the often intimidating med math and drug calculations! When you finish this course you’ll be able to confidently and safely administer medications to your patients!

Course Lessons

0 - Pharmacology Course Introduction
Pharmacology Course Introduction
1 - NCLEX Must Knows
12 Points to Answering Pharmacology Questions
54 Common Medication Prefixes and Suffixes
Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
Essential NCLEX Meds by Class
6 Rights of Medication Administration
Pharmacodynamics
Pharmacokinetics
The SOCK Method – Overview
The SOCK Method – S
The SOCK Method – O
The SOCK Method – C
The SOCK Method – K
2 - Math for Meds
Basics of Calculations
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
Oral Medications
Injectable Medications
IV Infusions (Solutions)
Complex Calculations (Dosage Calculations/Med Math)
Interactive Pharmacology Practice
Interactive Practice Drip Calculations
Pediatric Dosage Calculations
3 - Disease Specific Medications
Disease Specific Medications
4 - Antianxiety Agents
Antianxiety Meds
Benzodiazepines
Alprazolam (Xanax) Nursing Considerations
Lorazepam (Ativan) Nursing Considerations
Midazolam (Versed) Nursing Considerations
Diazepam (Valium) Nursing Considerations
Buspirone (Buspar) Nursing Considerations
Antianxiety Meds
5 - Antiarrhythmics
ACLS (Advanced cardiac life support) Drugs
Amiodarone (Pacerone) Nursing Considerations
Adenosine (Adenocard) Nursing Considerations
Procainamide (Pronestyl) Nursing Considerations
6 - Anticoagulants & Thrombolytics
Anti-Platelet Aggregate
Clopidogrel (Plavix) Nursing Considerations
Coumarins
Warfarin (Coumadin) Nursing Considerations
Thrombin Inhibitors
Enoxaparin (Lovenox) Nursing Considerations
Heparin (Hep-Lock) Nursing Considerations
Thrombolytics
Alteplase (tPA, Activase) Nursing Considerations
Streptokinase (Streptase) Nursing Considerations
7 - Anticonvulsants
Anticonvulsants
Carbamazepine (Tegretol) Nursing Considerations
Divalproex (Depakote) Nursing Considerations
Gabapentin (Neurontin) Nursing Considerations
Lamotrigine (Lamictal) Nursing Considerations
Levetiracetam (Keppra) Nursing Considerations
Phenytoin (Dilantin) Nursing Considerations
8 - Antidepressants
Antidepressants
Bupropion (Wellbutrin) Nursing Considerations
MAOIs
Selegiline (Eldepyrl) Nursing Considerations
SSRIs
Escitalopram (Lexapro) Nursing Considerations
Fluoxetine (Prozac) Nursing Considerations
Paroxetine (Paxil) Nursing Considerations
Sertraline (Zoloft) Nursing Considerations
TCAs
Amitriptyline (Elavil) Nursing Considerations
9 - Antidiabetic Agents
Antidiabetic Agents
Glipizide (Glucotrol) Nursing Considerations
Metformin (Glucophage) Nursing Considerations
Insulin
Insulin – Rapid Acting (Novolog, Humalog) Nursing Considerations
Insulin – Short Acting (Regular) Nursing Considerations
Insulin – Intermediate Acting (NPH) Nursing Considerations
Insulin – Mixtures (70/30)
Insulin – Long Acting (Lantus) Nursing Considerations
10 - Antihistamines
Histamine 1 Receptor Blockers
Diphenhydramine (Benadryl) Nursing Considerations
Promethazine (Phenergan) Nursing Considerations
Histamine 2 Receptor Blockers
Cimetidine (Tagamet) Nursing Considerations
Famotidine (Pepcid) Nursing Considerations
Ranitidine (Zantac) Nursing Considerations
11 - Antihypertensives
Renin Angiotensin Aldosterone System
Sympatholytics (Alpha & Beta Blockers)
Atenolol (Tenormin) Nursing Considerations
Metoprolol (Toprol XL) Nursing Considerations
Propranolol (Inderal) Nursing Considerations
ACE (angiotensin-converting enzyme) Inhibitors
Captopril (Capoten) Nursing Considerations
Enalapril (Vasotec) Nursing Considerations
Lisinopril (Prinivil) Nursing Considerations
Angiotensin Receptor Blockers
Losartan (Cozaar) Nursing Considerations
Calcium Channel Blockers
Amlodipine (Norvasc) Nursing Considerations
Diltiazem (Cardizem) Nursing Considerations
Nifedipine (Procardia) Nursing Considerations
Verapamil (Calan) Nursing Considerations
Cardiac Glycosides
Digoxin (Lanoxin) Nursing Considerations
12 - Anti-Infectives
Anti-Infective – Aminoglycosides
Gentamicin (Garamycin) Nursing Considerations
Anti-Infective – Antifungals
Metronidazole (Flagyl) Nursing Considerations
Nystatin (Mycostatin) Nursing Considerations
Anti-Infective – Antitubercular
Isoniazid (Niazid) Nursing Considerations
Rifampin (Rifadin) Nursing Considerations
Anti-Infective – Antivirals
Acyclovir (Zovirax) Nursing Considerations
Anti-Infective – Carbapenems
Meropenem (Merrem) Nursing Considerations
Anti-Infective – Fluoroquinolones
Ciprofloxacin (Cipro) Nursing Considerations
Levofloxacin (Levaquin) Nursing Considerations
Anti-Infective – Glycopeptide
Vancomycin (Vancocin) Nursing Considerations
Anti-Infective – Lincosamide
Clindamycin (Cleocin) Nursing Considerations
Anti-Infective – Macrolides
Erythromycin (Erythrocin) Nursing Considerations
Azithromycin (Zithromax) Nursing Considerations
Anti-Infective – Penicillins and Cephalosporins
Amoxicillin (Amoxil) Nursing Considerations
Ampicillin (Omnipen) Nursing Considerations
Cefaclor (Ceclor) Nursing Considerations
Cefdinir (Omnicef) Nursing Considerations
Cephalexin (Keflex) Nursing Considerations
Anti-Infective – Sulfonamides
Trimethoprim-Sulfamethoxazole (Bactrim) Nursing Considerations
Anti-Infective – Tetracyclines
Tetracycline (Panmycin) Nursing Considerations
13 - Antipsychotics
Atypical Antipsychotics
Chlorpromazine (Thorazine) Nursing Considerations
Antipsychotics
Haloperidol (Haldol) Nursing Considerations
Quetiapine (Seroquel) Nursing Considerations
Olanzapine (Zyprexa) Nursing Considerations
14 - Autonomic Nervous System Meds
Autonomic Nervous System (ANS)
Methylphenidate (Concerta) Nursing Considerations
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Dobutamine (Dobutrex) Nursing Considerations
Dopamine (Inotropin) Nursing Considerations
Carbidopa-Levodopa (Sinemet) Nursing Considerations
Parasympathomimetics (Cholinergics) Nursing Considerations
Neostigmine (Prostigmin) Nursing Considerations
Parasympatholytics (Anticholinergics) Nursing Considerations
Atropine (Atropen) Nursing Considerations
Benztropine (Cogentin) Nursing Considerations
Diphenoxylate-Atropine (Lomotil) Nursing Considerations
15 - Bronchodilators & Respiratory Drugs
Guaifenesin (Mucinex) Nursing Considerations
Bronchodilators
Albuterol (Ventolin) Nursing Considerations
Montelukast (Singulair) Nursing Considerations
Salmeterol (Serevent) Nursing Considerations
16 - Diuretics
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Furosemide (Lasix) Nursing Considerations
Hydrochlorothiazide (Hydrodiuril) Nursing Considerations
Spironolactone (Aldactone) Nursing Considerations
Mannitol (Osmitrol) Nursing Considerations
17 - GI Meds
Bisacodyl (Dulcolax) Nursing Considerations
Bismuth Subsalicylate (Pepto-Bismol) Nursing Considerations
Lactulose (Generlac) Nursing Considerations
Loperamide (Imodium) Nursing Considerations
Metoclopramide (Reglan) Nursing Considerations
Ondansetron (Zofran) Nursing Considerations
Pancrelipase (Pancreaze) Nursing Considerations
Sucralfate (Carafate) Nursing Considerations
Proton Pump Inhibitors
Omeprazole (Prilosec) Nursing Considerations
Pantoprazole (Protonix) Nursing Considerations
18 - Hormone & Immune Related Drugs
Epoetin Alfa
Epoetin (Epogen) Nursing Considerations
Glucagon (GlucaGen) Nursing Considerations
Iodine Nursing Considerations
Levothyroxine (Synthroid)
Propylthiouracil (PTU) Nursing Considerations
Cyclosporine (Sandimmune) Nursing Considerations
19 - Lipid Lowering Drugs
HMG-CoA Reductase Inhibitors (Statins)
Atorvastatin (Lipitor) Nursing Considerations
20 - Mineral and Electrolyte Drugs
Magnesium Sulfate
Magnesium Sulfate in Pregnancy
Magnesium Sulfate (MgSO4) Nursing Considerations
Calcium Acetate (PhosLo) Nursing Considerations
Calcium Carbonate (Tums) Nursing Considerations
Ferrous Sulfate (Iron) Nursing Considerations
Alendronate (Fosamax) Nursing Considerations
21 - Mood Stabilizers
Mood Stabilizers
Lithium (Lithonate) Nursing Considerations
22 - Non-Opioid Analgesics
Acetaminophen (Tylenol) Nursing Considerations
Phenazopyridine (Pyridium) Nursing Considerations
NSAIDs
ASA (Aspirin) Nursing Considerations
Celecoxib (Celebrex) Nursing Considerations
Ibuprofen (Motrin) Nursing Considerations
Indomethacin (Indocin) Nursing Considerations
Ketorolac (Toradol) Nursing Considerations
Naproxen (Aleve) Nursing Considerations
23 - OB Meds
Tocolytics
Terbutaline (Brethine) Nursing Considerations
Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
Meds for Postpartum Hemorrhage (PPH)
Methylergonovine (Methergine) Nursing Considerations
Oxytocin (Pitocin) Nursing Considerations
Prostaglandins in Pregnancy
Rh Immune Globulin in Pregnancy
Lung Surfactant for Newborns
Eye Prophylaxis for Newborn
Phytonadione (Vitamin K) for Newborn
Hepatitis B Vaccine for Newborns
24 - Opioid Analgesics
Opioids
Opioid Analgesics in Pregnancy
Butorphanol (Stadol) Nursing Considerations
Codeine (Paveral) Nursing Considerations
Fentanyl (Duragesic) Nursing Considerations
Hydrocodone-Acetaminophen (Vicodin, Lortab) Nursing Considerations
Hydromorphone (Dilaudid) Nursing Considerations
Meperidine (Demerol) Nursing Considerations
Methadone (Methadose) Nursing Considerations
Morphine (MS Contin) Nursing Considerations
Nalbuphine (Nubain) Nursing Considerations
Oxycodone (OxyContin) Nursing Considerations
25 - Sedatives / Hyponotics
Sedatives-Hypnotics
Barbiturates
Phenobarbital (Luminal) Nursing Considerations
Pentobarbital (Nembutal) Nursing Considerations
Anesthetic Agents
Propofol (Diprivan) Nursing Considerations
Lidocaine (Xylocaine) Nursing Considerations
26 - Steroids
Corticosteroids
Betamethasone and Dexamethasone in Pregnancy
Cortisone (Cortone) Nursing Considerations
Dexamethasone (Decadron) Nursing Considerations
Fluticasone (Flonase) Nursing Considerations
Methylprednisolone (Solu-Medrol) Nursing Considerations
27 - Vasodilators
Hydralazine
Hydralazine (Apresoline) Nursing Considerations
Nitro Compounds
Nitroglycerin (Nitrostat) Nursing Considerations
Nitroprusside (Nitropress) Nursing Considerations
28 - Vasopressors
Vasopressin
Epinephrine (EpiPen) Nursing Considerations
Norepinephrine (Levophed) Nursing Considerations
Vasopressin (Pitressin) Nursing Considerations
29 - Medications By Class
ACLS (Advanced cardiac life support) Drugs
Anti-Infective – Aminoglycosides
Anti-Infective – Carbapenems
Anti-Infective – Macrolides
Anti-Infective – Fluoroquinolones
Anti-Infective – Sulfonamides
Anti-Infective – Tetracyclines
Anti-Infective – Antifungals
Anti-Infective – Antivirals
Anti-Infective – Lincosamide
Thrombolytics
Anticonvulsants
Antidiabetic Agents
Sympatholytics (Alpha & Beta Blockers)
Anti-Infective – Antitubercular
Anti-Infective – Glycopeptide
Bronchodilators
Opioids
Barbiturates
Anesthetic Agents
30- Antineoplastics
Antineoplastics
Alkylating Agents
Antimetabolites
Anti Tumor Antibiotics
Plant Alkaloids Topoisomerase and Mitotic Inhibitors
31 – Medication Infusion
Patient Controlled Analgesia (PCA)
Epidural
Insulin Drips