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)
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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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Concepts Covered:

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

Study Plan Lessons

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