Oral Medications

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Nichole Weaver
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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)
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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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Study Plan for Study Skills, Test Taking for the NCLEX® Using Med-Surg (Lewis 10th ed.) designed for Westmoreland County Community College

Concepts Covered:

  • Concepts of Population Health
  • Factors Influencing Community Health
  • Community Health Overview
  • Substance Abuse Disorders
  • Upper GI Disorders
  • Renal Disorders
  • Newborn Care
  • Integumentary Disorders
  • Tissues and Glands
  • Central Nervous System Disorders – Brain
  • Digestive System
  • Urinary Disorders
  • Urinary System
  • Musculoskeletal Trauma
  • Concepts of Mental Health
  • Health & Stress
  • Developmental Theories
  • Fundamentals of Emergency Nursing
  • Communication
  • Basics of NCLEX
  • Test Taking Strategies
  • Prioritization
  • Delegation
  • Emotions and Motivation
  • Integumentary Disorders
  • Legal and Ethical Issues
  • Basic
  • Preoperative Nursing
  • Labor and Delivery
  • Fetal Development
  • Newborn Complications
  • Postpartum Complications
  • Postpartum Care
  • Labor Complications
  • Pregnancy Risks
  • Prenatal Concepts
  • Circulatory System
  • Cardiac Disorders
  • Emergency Care of the Cardiac Patient
  • Vascular Disorders
  • Shock
  • Postoperative Nursing
  • Intraoperative Nursing
  • Oncology Disorders
  • Neurological Emergencies
  • Respiratory Disorders
  • Female Reproductive Disorders
  • Acute & Chronic Renal Disorders
  • Liver & Gallbladder Disorders
  • Lower GI Disorders
  • Disorders of Pancreas
  • Disorders of the Thyroid & Parathyroid Glands
  • Disorders of the Adrenal Gland
  • Disorders of the Posterior Pituitary Gland
  • Immunological Disorders
  • Hematologic Disorders
  • EENT Disorders
  • Integumentary Important Points
  • Musculoskeletal Disorders
  • Emergency Care of the Neurological Patient
  • Peripheral Nervous System Disorders
  • Central Nervous System Disorders – Spinal Cord
  • Neurologic and Cognitive Disorders
  • Eating Disorders
  • Noninfectious Respiratory Disorder
  • Respiratory Emergencies
  • Infectious Respiratory Disorder
  • Psychological Emergencies
  • Trauma-Stress Disorders
  • Personality Disorders
  • Cognitive Disorders
  • Bipolar Disorders
  • Depressive Disorders
  • Psychotic Disorders
  • Anxiety Disorders
  • Somatoform Disorders
  • Infectious Disease Disorders
  • Musculoskeletal Disorders
  • Renal and Urinary Disorders
  • Cardiovascular Disorders
  • EENT Disorders
  • Gastrointestinal Disorders
  • Hematologic Disorders
  • Oncologic Disorders
  • Endocrine and Metabolic Disorders
  • Childhood Growth and Development
  • Adulthood Growth and Development
  • Medication Administration
  • Nervous System
  • Dosage Calculations
  • Learning Pharmacology
  • Prefixes
  • Suffixes

Study Plan Lessons

Communicable Diseases
Disasters & Bioterrorism
Cultural Care
Environmental Health
Technology & Informatics
Epidemiology
Health Promotion & Disease Prevention
Head to Toe Nursing Assessment (Physical Exam)
Enteral & Parenteral Nutrition (Diet, TPN)
Specialty Diets (Nutrition)
Blood Glucose Monitoring
Intake and Output (I&O)
Hygiene
Pain and Nonpharmacological Comfort Measures
Bowel Elimination
Urinary Elimination
Complications of Immobility
Patient Positioning
Defense Mechanisms
Overview of Developmental Theories
Abuse
Therapeutic Communication
Overview of the Nursing Process
Triage
Prioritization
Delegation
Maslow’s Hierarchy of Needs in Nursing
Isolation Precaution Types (PPE)
Fall and Injury Prevention
Fire and Electrical Safety
Brief CPR (Cardiopulmonary Resuscitation) Overview
HIPAA
Advance Directives
Legal Considerations
Process of Labor
Fetal Circulation
Fetal Environment
Newborn of HIV+ Mother
Hyperbilirubinemia (Jaundice)
Transient Tachypnea of Newborn
Meconium Aspiration
Babies by Term
Newborn Reflexes
Body System Assessments
Newborn Physical Exam
Postpartum Hemorrhage (PPH)
Mastitis
Initial Care of the Newborn (APGAR)
Breastfeeding
Postpartum Discomforts
Postpartum Physiological Maternal Changes
Dystocia
Precipitous Labor
Preterm Labor
Abruptio Placentae (Placental abruption)
Placenta Previa
Prolapsed Umbilical Cord
Fetal Heart Monitoring (FHM)
Leopold Maneuvers
Mechanisms of Labor
Fetal Development
Infections in Pregnancy
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Gestational HTN (Hypertension)
Hydatidiform Mole (Molar pregnancy)
Ectopic Pregnancy
Disseminated Intravascular Coagulation (DIC)
Gestational Diabetes (GDM)
Nutrition in Pregnancy
Chorioamnionitis
Antepartum Testing
Discomforts of Pregnancy
Physiological Changes
Maternal Risk Factors
Fundal Height Assessment for Nurses
Gravidity and Parity (G&Ps, GTPAL)
Gestation & Nägele’s Rule: Estimating Due Dates
Family Planning & Contraception
Menstrual Cycle
Hemodynamics
Normal Sinus Rhythm
Performing Cardiac (Heart) Monitoring
Preload and Afterload
Sinus Bradycardia
Sinus Tachycardia
Atrial Fibrillation (A Fib)
Premature Ventricular Contraction (PVC)
Ventricular Tachycardia (V-tach)
Ventricular Fibrillation (V Fib)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology for Heart Failure (CHF)
Nursing Care and Pathophysiology of Angina
Pacemakers
Nursing Care and Pathophysiology of Hypertension (HTN)
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Cardiogenic Shock
Nursing Care and Pathophysiology for Distributive Shock
Discharge (DC) Teaching After Surgery
Postoperative (Postop) Complications
Post-Anesthesia Recovery
Malignant Hyperthermia
Moderate Sedation
Local Anesthesia
Preoperative (Preop)Assessment
General Anesthesia
Preoperative (Preop) Nursing Priorities
Preoperative (Preop) Education
Informed Consent
Biopsy
Ultrasound
Echocardiogram (Cardiac Echo)
Cardiovascular Angiography
Cerebral Angiography
Magnetic Resonance Imaging (MRI)
X-Ray (Xray)
Computed Tomography (CT)
Nursing Care and Pathophysiology for Menopause
Nursing Care and Pathophysiology for Endometriosis
Nursing Care and Pathophysiology for Pelvic Inflammatory Disease (PID)
Dialysis & Other Renal Points
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology of Urinary Tract Infection (UTI)
Nursing Care and Pathophysiology of Glomerulonephritis
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology of Acute Kidney (Renal) Injury (AKI)
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care and Pathophysiology for Crohn’s Disease
Nursing Care and Pathophysiology for Ulcerative Colitis(UC)
Nursing Care and Pathophysiology for Inflammatory Bowel Disease (IBD)
Nursing Care and Pathophysiology for Appendicitis
Nursing Care and Pathophysiology for Peptic Ulcer Disease (PUD)
Nursing Care and Pathophysiology for Pancreatitis
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Diabetes Management
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Addisons Disease
Nursing Care and Pathophysiology for Anaphylaxis
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Oncology Important Points
Lymphoma
Leukemia
Blood Transfusions (Administration)
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Glaucoma
Macular Degeneration
Hearing Loss
Fractures
Cataracts
Integumentary (Skin) Important Points
Nursing Care and Pathophysiology of Osteoarthritis (OA)
Nursing Care and Pathophysiology of Osteoporosis
Burn Injuries
Pressure Ulcers/Pressure injuries (Braden scale)
Nursing Care and Pathophysiology for Herpes Zoster – Shingles
Nursing Care and Pathophysiology for Meningitis
Nursing Care and Pathophysiology for Seizure
Seizure Therapeutic Management
Seizure Assessment
Seizure Causes (Epilepsy, Generalized)
Stroke Nursing Care (CVA)
Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
Stroke Therapeutic Management (CVA)
Stroke Assessment (CVA)
Nursing Care and Pathophysiology for Hemorrhagic Stroke (CVA)
Miscellaneous Nerve Disorders
Nursing Care and Pathophysiology for Parkinsons
Nursing Care and Pathophysiology for Multiple Sclerosis (MS)
Cerebral Perfusion Pressure CPP
Intracranial Pressure ICP
Adjunct Neuro Assessments
Levels of Consciousness (LOC)
Routine Neuro Assessments
Hemoglobin A1c (HbA1C)
Glucose Lab Values
Urinalysis (UA)
Creatinine (Cr) Lab Values
Blood Urea Nitrogen (BUN) Lab Values
Ammonia (NH3) Lab Values
Cholesterol (Chol) Lab Values
Albumin Lab Values
Coagulation Studies (PT, PTT, INR)
Platelets (PLT) Lab Values
White Blood Cell (WBC) Lab Values
Hematocrit (Hct) Lab Values
Red Blood Cell (RBC) Lab Values
Hemoglobin (Hbg) Lab Values
Chloride-Cl (Hyperchloremia, Hypochloremia)
Sodium-Na (Hypernatremia, Hyponatremia)
Potassium-K (Hyperkalemia, Hypokalemia)
Hypertonic Solutions (IV solutions)
Hypotonic Solutions (IV solutions)
Isotonic Solutions (IV solutions)
Base Excess & Deficit
Metabolic Alkalosis
Metabolic Acidosis (interpretation and nursing diagnosis)
Respiratory Alkalosis
Respiratory Acidosis (interpretation and nursing interventions)
ABG (Arterial Blood Gas) Interpretation-The Basics
ABGs Nursing Normal Lab Values
Chest Tube Management
Nursing Care and Pathophysiology of Pneumonia
Artificial Airways
Airway Suctioning
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology for Tuberculosis (TB)
Lung Sounds
Alveoli & Atelectasis
Gas Exchange
Nursing Care and Pathophysiology for Asthma
Suicidal Behavior
Eating Disorders (Anorexia Nervosa, Bulimia Nervosa)
Alcohol Withdrawal (Addiction)
Grief and Loss
Paranoid Disorders
Personality Disorders
Cognitive Impairment Disorders
Mood Disorders (Bipolar)
Depression
Schizophrenia
Generalized Anxiety Disorder
Post-Traumatic Stress Disorder (PTSD)
Somatoform
Dissociative Disorders
Anxiety
Pertussis – Whooping Cough
Varicella – Chickenpox
Mumps
Rubeola – Measles
Scoliosis
Attention Deficit Hyperactivity Disorder (ADHD)
Autism Spectrum Disorders
Spina Bifida – Neural Tube Defect (NTD)
Meningitis
Enuresis
Nephrotic Syndrome
Cerebral Palsy (CP)
Mixed (Cardiac) Heart Defects
Obstructive Heart (Cardiac) Defects
Defects of Decreased Pulmonary Blood Flow
Defects of Increased Pulmonary Blood Flow
Congenital Heart Defects (CHD)
Cystic Fibrosis (CF)
Asthma
Acute Otitis Media (AOM)
Bronchiolitis and Respiratory Syncytial Virus (RSV)
Tonsillitis
Conjunctivitis
Constipation and Encopresis (Incontinence)
Intussusception
Appendicitis
Celiac Disease
Pediatric Gastrointestinal Dysfunction – Diarrhea
Vomiting
Hemophilia
Nephroblastoma
Fever
Dehydration
Sickle Cell Anemia
Burn Injuries
Pediculosis Capitis
Impetigo
Eczema
Growth & Development – School Age- Adolescent
Growth & Development – Preschoolers
Growth & Development – Toddlers
Growth & Development – Infants
Care of the Pediatric Patient
Vitals (VS) and Assessment
Vasopressin
TCAs
SSRIs
Proton Pump Inhibitors
Vancomycin (Vancocin) Nursing Considerations
Ciprofloxacin (Cipro) Nursing Considerations
Metronidazole (Flagyl) Nursing Considerations
Anti-Infective – Penicillins and Cephalosporins
Parasympatholytics (Anticholinergics) Nursing Considerations
NSAIDs
Nitro Compounds
MAOIs
Hydralazine (Apresoline) Nursing Considerations
Insulin
Magnesium Sulfate
HMG-CoA Reductase Inhibitors (Statins)
Histamine 2 Receptor Blockers
Histamine 1 Receptor Blockers
Epoetin Alfa
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Corticosteroids
Benzodiazepines
Cardiac Glycosides
Calcium Channel Blockers
Parasympathomimetics (Cholinergics) Nursing Considerations
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Autonomic Nervous System (ANS)
Atypical Antipsychotics
Angiotensin Receptor Blockers
ACE (angiotensin-converting enzyme) Inhibitors
Renin Angiotensin Aldosterone System
Complex Calculations (Dosage Calculations/Med Math)
IV Infusions (Solutions)
Injectable Medications
Oral Medications
Basics of Calculations
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
The SOCK Method – K
The SOCK Method – C
The SOCK Method – O
The SOCK Method – S
The SOCK Method – Overview
6 Rights of Medication Administration
Essential NCLEX Meds by Class
12 Points to Answering Pharmacology Questions
Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
54 Common Medication Prefixes and Suffixes