CDS Chapter 9 Reading Medication Labels and Syringes

By way of the gastrointestinal tract.

The physical form in which a medication is manufactured and dispensed (e.g., solid tablet or a liquid elixir).

Inserted under or into the skin

Intradermal injection:
An injection into the skin layer.

Intramuscular injection:
An injection into the muscle

Intravenous injection:
An injection directly into the vein.

The curved surface of a liquid in a container.

By way of a route other than through the gastrointestinal tract (for example, by injection into tissue or into a vein

Owned by an individual or company under a patent or trademark.

Subcutaneous injection:
An injection into the tissue under the skin, but above the muscle.

The process of bringing a powder to normal strength by adding a liquid

Medication labels and package inserts contain a lot of information about a drug, including:
The chemical composition
What disease or disorder the drug is used to treat
Prescribing guidelines
Known adverse drug reactions and interactions
Warnings and cautions about the use of the drug

A nurse must be able to read and interpret this information in order to fulfill the
six rights of safe medication administration.

Drug Names
Chemical name, Generic name, Trade name, National Drug Code Number

Chemical name
Describes the drug’s chemical properties.
The chemical name is usually not printed on the drug label, but should be included in the package insert.

Generic name
The generic name is the name of the medication as registered with the United States Pharmacopeia-National Formulary (USP-NF).
The generic name is identified by the abbreviation USP after the drug name on a drug label.

Trade name
Trade name is another name for brand name.
This is the name that the manufacturer applies to the drug.
The selected name is proprietary and can be used only by the company that owns the trademark.
A trademarked name will be signified by the symbol ®, which means the name is registered with the United States Patent and Trademark Office

National Drug Code Number
The National Drug Code (NDC) number is a three-segment, 10-digit number used for prescription drugs and insulin products made for commercial distribution.

The NDC number identifies:
The labeler of the drug
The strength, dosage, form, and formulation of the drug
The pharmacological class of the drug
The package size of the drug, which identifies the size and type of package

A search of the FDA’s National Drug Code Directory reveals the following about Biaxin®:
It was introduced to the drug market in October, 1991 by Abbott Laboratories
It is a member of the Macrolide class of antibiotics
There are 60 film-coated tablets in each bottle

Drug labels must list the
form of the medication.

Medications come in many forms:
aerosols for inhalation, tablets, capsules, creams, elixirs, emulsions, enemas, granules, injections, powders, troches, solutions, suspensions, and syrups.

Medication labels must list the
route(s) of administration.

The medication label may also warn the user about ways the
drug should NOT be administered if it is a high-risk drug.

For example, some medications may be designed to be administered through an intramuscular injection,
but must not be given intravenously.

The dosage strength of the drug is the
amount of active ingredient per dosage unit.

The dosage unit is the form of the medication
those most common are mL (for liquids) and tablets or capsules (for solids).

The amount of the active ingredient will be listed
in g, mg, mcg, units, or milliequivalents (mEq).

Some medications have two or more active ingredients
which may be present in varying amounts.

For example, the drug Lortab 5/500,
contains the narcotic hydrocodone 5 mg and acetaminophen 500 mg

Lortab comes in multiple strengths:
7.5/500 and 10/500. It is important to carefully read the drug label so the correct strength is selected.

Lot Number and Expiration Date
The lot number is an identification number assigned to a quantity of medication made by a manufacturer.
If a medication is found to be contaminated, the lot number provides a trail by which the drug maker can examine the manufacturing process for errors.
The expiration date is the date by which the manufacturer guarantees that the medication will be chemically stable and its potency and safety maintained.
Medications that have passed this date have expired and should be returned to the facility’s pharmacy for disposal.

Other Label Information
Storage instructions
Some drugs must be stored in carefully controlled environments to maintain their potency and efficacy.
Information about potentially harmful side effects, use during pregnancy and lactation, or other points deemed important by the manufacturer.

Directions for mixing or reconstituting Some medications
must be mixed with a diluent before administration.

Usual dosage
Some labels may provide usual dosage instructions. If not, this information can be found in the package insert. The usual dosage may not be the same as the dosage prescribed by the provider.

The Package Insert
The package insert is a document that is included in the medications surrounding box or wrapper.
The insert contains information about the medication in far more detail than the sticker label.
If the package insert is not available, most nursing units have drug reference material readily available in book or electronic form.

The package insert contains the full prescribing information including:
Indications and usage
Dosage and administration
Dosage forms and strengths
Contraindications (known hazards)
Warnings and precautions
Adverse reactions (clinical studies and post-marketing experiences)
Drug and food interactions
Use in specific populations (use in pregnancy/lactation, use with pediatric and geriatric patients, and use in patients with kidney or liver problems)
How to treat an overdose
Description of the drug
Clinical pharmacology (mechanisms of action, pharmacokinetics, and pharmacodynamics)

The Package Insert (cont’d)
Nonclinical toxicology (ability of the drug to cause cancer or impair fertility)
Clinical studies findings
How the drug is supplied
Storage and handling instructions
Patient counseling information (teaching points)

Oral medications come in
solid or liquid forms

Solid forms
Tablets: medication is mixed with a powder-based binder and molded into a shape.
Capsules: medication is contained within hard or soft shells. May be immediately acting or of the delayed or extended-release variety.
Granules: Small particles of medication that are dissolved in liquid before dispensing.

Tablets come in many different forms, including:
Coated: coating protects the tablet from the environment, masks an unpleasant taste, or prevents the tablet from being dissolved in the stomach.
Effervescent: releases carbon dioxide gas when tablet is dissolved in water.
Modified release
Delayed release tablets release the drug at a time after swallowing.
Extended release tablets release the drug over an extended amount of time.

Oral Medications (cont’d)
Multilayer: contains multiple layers of ingredients
Orally disintegrating: dissolves rapidly in the mouth
Soluble: dissolves in liquid
Troche: flavored disks that are placed in the mouth and meant to dissolve slowly
Lozenge: medication is combined with a sweetened, flavored base. Meant to dissolve slowly in the mouth

Most tablets and capsules are
meant to be swallowed in their whole form.

If the patient is unable to swallow,
it may be necessary to divide or crush tablets or open capsules.

Before crushing tablets or opening capsules,
check a drug guide or another reliable source to make sure the intended activity of the drug will not change.

Liquid forms
Solutions: clear fluids free from precipitates (solid particles)
Suspensions: solutions that contain undissolved, solid particles
Emulsions: liquids that are suspended in another liquid in droplet form
Elixirs: clear solutions that have been flavored or sweetened
Syrups: contain high amounts of sugar

Measuring Oral Medications
Liquid medications must be measured using a calibrated measuring device, such as a dosing cup, oral syringe, dropper, or a cylindrical spoon.
If the medication comes with its own delivery device, the device should be used as it has been calibrated to deliver the correct amount of medication.

Dosing Cups
Suitable for liquid medications that do not require precise dosing.
The cup holds up to 30 mL of liquid and is calibrated in 5 mL markings.
To use the cup, place it on a level surface. With the cup at eye level, pour the liquid into the cup until the medication is level with the desired dose marking.
The cup may also contain calibrations for fluid ounces and the obsolete apothecary measure of drams, so take care not to confuse the dosage markings when pouring medications.

Oral Syringes
These syringes have several features that distinguish them from hypodermic syringes.
The tip of the syringe does not fit adapters and devices made for hypodermic syringes.
This prevents medications meant for oral administration from being administered intravenously or injected into tissues.
Oral syringes have offset, non-luer-lock tips or orange-colored barrels.
They may also include household measures (such as teaspoon), as well as metric measures.

Used to administer small amounts of medications, typically up to 5 mL.
The size dropper selected should be appropriate to the amount of medication to be given.
Even so, obtaining exact measurements can be difficult, depending on the pressure on the dropper’s bulb.

Cylindrical Spoons
Cylindrical spoons are calibrated in 1 mL increments.
Used to administer liquids that do not require precise measurements.
The spoon is used more in the home environment rather than hospitals.

Calculating Oral Dosages
Calculating tablet dosages is simple.
In general, tablets are given whole or in halves if the tablet is scored.
Tablets that are not pre-scored should not be divided.

Drugs can be injected into the:
Skin (intradermal or ID)
Subcutaneous tissue (subcutaneous or subcut)
Muscles (intramuscular or IM)
Vein (intravenous or IV)

Medications given by injection into veins or into tissues are
said to be given by the parenteral route.

Nurses typically only perform
ID, subcut, IM, and IV Injections.

The Barrel
Contains a calibrated dosing scale.
Has a hub at one end and a flange at the other end.
The hub of the syringe is either a slip-tip or luer-lock design.
Needles attached to a slip-tip hub can be easily removed (or slipped) from the syringe by pulling the two pieces apart.
Luer-lock hubs are threaded to allow needles and other devices to be connected securely to the syringe.
The barrel’s flange provides counter pressure for the plunger when injecting medication.

Parts of a Hypodermic Syringe
The Needle
Range in length from 1/4 inch to 4 inches.
Intradermal and subcutaneous injections require short needles.
Intramuscular injections use longer needles (1 inch to 3 inches depending upon the size of the person)
Range in gauge (diameter of needle) from fine (31 gauge) to large (14 gauge).
This needle has an orange safety cap to protect against needlesticks.

The Plunger
The plunger slides within the interior of the syringe.
The tip of the plunger is usually made of a black rubber-like material and has two rings that make contact with the interior walls of the barrel.
The ring closest to the medication is where the dose is read.
The flange at the end of the plunger allows the nurse to manipulate the plunger without touching the sterile portion.

Syringe Types and Sizes
Hypodermic syringes come in varying sizes.
1-mL, 3-mL, 5 or 6-mL, 10 or 12-mL, 20 or 30-mL, and 60-mL.
The 1-mL syringe.
Also known as a tuberculin syringe as it is used to administer the tuberculosis (TB) skin test.
It is calibrated in increments of 0.01 mL between the short lines, and 0.1 mL between the dark, longer lines.
The medium-size lines in between the longer markings indicate 0.05 mL.
Besides being used for the TB skin test, the 1-mL syringe is useful for administering very small, precise amounts of medication.

Insulin Syringes
Calibrated in units instead of mL
Designed to be used with insulin only
Insulin syringes come in varying sizes, from 30 units to 100 units and typically come with the needle permanently attached to the syringe.

Calculating dosages for medications given parenterally follows the
same process as calculating dosages for oral liquid medications.

Medications injected intradermally, subcutaneously, or intramuscularly are
given in small quantities due to the limited capacity of these tissues to accept fluids.

Intradermal injections are
limited to 0.1 mL

Subcutaneous injections are
limited to 1 mL

Intramuscular injections are
limited to 4 to 5 mL

If you calculate an answer for a particular injection site that is greater than the guideline allows,
re-check your math!

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