Math 102 Week 02 Session 04 Agenda Su 09

MATH 102 WEEK 02 SESSION 04 AGENDA SU 09

Professor Luke Papademas [email protected]

● Welcome to MATH 102 Medical Mathematics ● Meet: Mondays - Thursdays 6 PM Room 2109 ● Meet: Wednesdays 6 PM Room 1836 ( Professor James ) Sometimes in the PC Lab Room ( Wednesday ) ● Avoir Du Pois Extra Credit ( consider cereal boxes and balance weights ) ● Online Web site: http://www.papademas.net/occ/MATH102 ● Quiz 2 tomorrow Wednesday ( Midterm Quiz ) Covers up to Chapter 6 Tomorrow – a sample quiz will be available today ● Lab Projects Tomorrow ( MS Excel – calculations, MS Internet Explorer – interactive Web applications )  Review Chapter 6 ( Calculation of Oral Medication Solids and Liquids ) ● Cover Chapter 7 ( Liquids for Injection ) ● Review Chapter 8 ( Calculations of Basic IV Drip Rates )

 Graded work tonight / tomorrow ( [email protected] )

 Thursday’s Deliverables include: Homework 4 and 5  Monday’s Deliverables include: Homework 6 and 7 CHPT 8 DUE TUESDAY!!

NF National Formulary USP United States Pharmacopeia PDR Physicians Desk Reference

Chapter 7 Liquids for Injection Page 153

When Supply is Given as a Percent

Example

Lidocaine 2% = 2 g in 100 mL Percents may be stated in three ways 2 g per 100 mL 2 g = 100 mL 2 g / 100 mL

Self – Test 4 ( Page 153 )

Write the following percentages in three ways.

Percentage ? g per 100 mL ? g = 100 mL ? g / 100 mL

0.9 % 0.9 g per 100 mL 0.9 g = 100 mL 0.9 g / 100 mL

1.5 % 1.5 g per 100 mL 1.5 g = 100 mL 1.5 g / 100 mL

Example Order: Lidocaine 30 mg for injection before suturing a wound Supply: Read the Label Label says:

Lidocaine HCL Injection, USP 2% 20 mg / mL ( really 2000 mg / 100 mL or 2 g / 100 mL ) The bottle contains 50 mL

D = 30 mg H = have S = supply X = unknown amount x = ( D / H ) * S = 30 mg / 20 mg * ( 1 mL ) x = 1.5 mL

Order: Magnesium Sulfate 1 g; add to IV stat

Supply: Read the Label Magnesium Sulfate Injection, USP 50 % ( 0.5 g / mL ) 1 g / 2 mL Equivalent: 50% means 50 g in 100 mL D = 1 g H = 50 g S = 100 mL X = unknown amount x = ( D / H ) * S = 1 g / 50 g * ( 100 mL ) x = 2 mL

Formula Method

Self – Test 5 Using Percentages with Liquids for Injection

1. Order: Epinephrine 5 mg subcutaneous stat Supply: ampule labeled 1 % Solve these problems involving percentages. Answers are in mL)

D = 0.005 g H = 1 g S = 100 mL X = unknown amount x = ( D / H ) * S = 0.005 g / 1 g * ( 100 mL ) x = 0.5 mL

Order: Prepare for IV use dextrose 5 g IV Supply: syringe labeled 50% Solve these problems involving percentages. Answers are in mL)

D = 5 g H = 50 g S = 100 mL X = unknown amount x = ( D / H ) * S = 5 g / 50 g * ( 100 mL ) x = 10 mL Page 156 Insulin Injections

Type Onset Peak Duration Regular 1 hour 2 – 4 hours 5 – 7 hours Humalog 5 minutes 1 hour 2 – 4 hours NPH or Lente 1 – 2.5 hours 6 – 12 hours 18 – 24 hours Ultralente 4 – 8 hours 12 – 20 hours 24 – 48 hours Mixed Insulins 30 – 60 minutes 2 – 4 hours then 6 – 8 hours then 18 – Then 1 – 2 hours 6 – 12 hours 24 hours Lantus 1 hour None 24 hours

Types of Insulin Syringes Order for insulin is usually given in units Figure 7 – 4 1 mL syringe marked in units 1 mL = 100 units (Each line indicates 2 units)

Figure 7 – 5 1/2 mL low – dose insulin syringe marked in units ½ mL = 50 units (Each line indicates 1 units)

Example: Order: 60 units NPH subcutaneous every day Supply: Read the label. Ask yourself three questions.

1. What is the order? NPH 60 units 2. What is the supply? NPH U 100 / mL 3. Is a U 100 insulin syringe available? Yes Using aseptic techniques, draw up the amount required into the syringe.

Mixing Two Insulins in One syringe

Remember two points: 1. Always draw the regular insulin into the syringe first. 2. The total number of units in the syringe equals the two insulin orders. Regular insulin = clear NPH = cloudy

Draw clear to cloudy

Self – Test Insulin Calculations

Solve these insulin problems. Draw a line on the syringe to indicate the dose you would prepare.

3. Order: regular Humilin 4 units subcutaneous stat Supply: vial regular insulin 100 units / mL

1 2 3 4 5 0 0 0 0 0 4

Example: Order: Monocid ( cefonicid sodium ) 0.65 g IM every day

Label directions: Add 2.5 mL sterile water for injection … shake well. Provides an approximate Volume of 3.1 mL ( 325 mg / mL )

D = 0.65 g

H = 1 g ( 325 mg / mL reconstituted )

S = 1 mL = 325 mg

x = ( D / H ) * S = 650 mg / 325 mg * ( 1 mL ) x = 2 mL

325 mg / mL 08/13/09 19:18 LP Expires 08/16/09 (if refrigerated 24 hrs at room temp.) Page 169 Steps for Reconstituting

1 Read the order 2 Identify the supply 3 Dilute the fluid 4 Identify the solution and new supply 5 Apply the rule and arithmetic 6 Obtain the amount to give 7 Write on the label the solution made, date, time, expiration date, your initials 8 Store according to directions

Example: Order: penicillin G potassium 1 million units IM q6h Supply powder: 5 million – unit vial

3 mL will provide 1,000,000 units / mL ( the chosen diluent )

D = 1,000,000 units

H = 1,000,000

S = 1 mL

x = ( D / H ) * S = 1,000,000 / 1,000,000 * ( 1 mL ) x = 1 mL

6. Scopolamine 0.6 mg subcutaneous stat Vial labeled 0.4 mg/ml x = ( 0.6 mg / 0.4mg ) * 1ml x = 1.5 ml

7. atropine sulfate 0.8 mg IV at 7 am Vial labeled 0.4 mg/mL

x = ( 0.8mg / 0.4 mg ) * 1 mL x = 2 mL

8. Add 0.5 g dextrose 25% to IV stat Vial of liquid labeled infant 25% dextrose injection 250mg/mL x = ( 500 mg / 250 mg ) * 1 mL x = 2 mL

Proficiency Test 2 pg 181

1. morphine sulfate 10 mg IV stat vial labeled 15 mg/mL

x = ( 10 mg / 15 mg ) * 1 mL x = 0.66 mL

3. phenobarbitol 0.1 g IM q6h ampule of liquid labeled 200mg/ 3mL

x = ( 100 mg / 200 mg ) * 3 mL x = 1.5 mL Proficiency Test 3 pg 183

1. Lanoxin (digoxin) 0.25 mg IM every day Ampule labeled 0.5 mg/2mL

x = ( 0.25mg / 0.5mg ) * 2 mL x = 1 mL

15. magnesium sulfate 500 mg IM Ampule labeled 50% (2 mL size) x = ( 0.5 g / 50 g ) * 2 mL x = 1 mL

Proficiency Test 4 pg 185 ORDER SUPPLY GIVE

1. 0.5 g IM 250 mg/mL 2 mL 2. 10 mEq IV 40 mEq/20 mL 5mL

Proficiency Test 4 pg 186 1. Fortaz (ceftazidime) 250 mg Vial of powder labeled 1-g powder (refer fig 7-15)

a. diluting fluid and number of mL: 3 mL b. Solution and new supply: 280 mg/mL c. Rule and arithmetic: ( 250mg / 280mg ) * 1 mL= 0.9mL d. Amount to give: 0.9 mL e. Write on label: AN , 08/15/09, 20:15, 3.6 mL f. Storage: refrigerated for 7 days, exp: 8/22/09

Chapter 8 Calculation of Basic IV Drip Rates pg 203

Written Order Supply Label

1000 mL D5W 1000 mL D5%W 500 mL D5S 500 mL D5%0.9%NS 250 mL D5 ½ NS 250 mL D5%0.45%NS 500 mL D5 1/3 NS 500 mL D5%0.33%NS 500 mL NS 500 mL 0.9%NS 1000 mL ½ NS 1000 mL 0.45%NS

Infusion sets without a small needle are called macrodrip. Drops per mL differ according to the manufacturer. Baxter-Travenol macrodrip sets deliver 10 gtt/mL Abbott sets deliver 15 gtt/mL

Example

250 mL D5W IV at 250 mL/hr Fluid amt: 250 mL Time: 1 hr

1000 mL Ringer’s lactate IV 8am-8pm Fluid amt: 1000 mL Time: 12 hrs

500 mL D5 ½ NS w/ 20 mEq KCI IV to run 75 mL/hr on a pump Fluid amt: 500 mL Time: 75mL/hr

DROP or DRIP factor=how many gtt per mL

Number of mL to infuse × TF ------Number of min to infuse = drops per minutes or gtts/min

Microdrip= 1 cc 60 gtt= 1mL Macrodrip = 10 gtt= 1mL

Order: 500 mL D5NS IV 12 noon- 4 pm Available: microdrip at 60 gtt/mL; macrodrip at 20 gtt/mL

The IV will run 4 hrs or 240 min. Because no pump is available, nurse must choose the drip factor.

MACRODRIP

500 mL to infuse × 20gtt/mL ------240min = 42 drops per minutes or gtts/min

MICRODRIP

500 mL to infuse × 60gtt/mL ------240 min = 125 drops per minutes or gtts/min

Self Test 1 pg 210

1. Order: 150 mL D5W 0.33NS IV q8h Available: infusion pump  (150mL × 60gtt/mL ) / 480 =

3. order: 1000 mL D5NS; run at 25 mL/hr Available: macrodrip (10 gtt/mL); microdrip (60gtt/mL)