Drugs for the Gastrointestinal System PDF

1\. Learning Step / Activity 1. Antiemetic Drugs. a. Pharmacology Overview: 1. Drugs used to relieve nausea and vomiting are called antiemetics drugs. a. **Serotonin (5-HT3) receptor antagonists** a. Action: reduce or halt nausea and vomiting by blocking 5-HT3 receptors in th...

1\. Learning Step / Activity 1. Antiemetic Drugs. a. Pharmacology Overview: 1. Drugs used to relieve nausea and vomiting are called antiemetics drugs. a. **Serotonin (5-HT3) receptor antagonists** a. Action: reduce or halt nausea and vomiting by blocking 5-HT3 receptors in the intestinal tract and the chemoreceptor trigger zone (CTZ) so that serotonin cannot activate these receptors. b. Side effects: dizziness, headache, drowsiness, changes in taste, heartburn, constipation, diarrhea, chills with shivering c. Adverse Effects: allergic reactions, dysrhythmias, and renal or liver damage, Serotonin Syndrome d. Nursing implications and patient teaching: i. Make sure the patient has a call light available because these drugs can cause dizziness. ii. Give the drug before the patient has an episode of vomiting because it can prevent or relieve nausea before the patient vomits. iii. ODTs dissolve in seconds after being placed on the tongue. After the tablet is dissolved, the patient may swallow. It does not need to be given with water. iv. Contact the healthcare provider if the patient is also taking drugs that affect serotonin levels because the interaction can cause serious adverse effects. v. These drugs may be given for postoperative nausea and vomiting but typically are delivered intravenously rather than orally. vi.  To avoid possible interactions, do not take any herbal agents without checking with a pharmacist or other healthcare provider while taking the serotonin 5-HT3 receptor antagonists. vii. Tell your healthcare provider if you are taking serotonin 5-HT3 receptor antagonists because these drugs interact with a variety of other drugs. viii. Avoid driving, operating heavy machinery, or participating in critical decision making while taking this drug because it may impair your judgment and reflexes. ix. It is best to take the drug before you have vomited rather than waiting until after you have had an episode of vomiting. x. Do not use alcohol or other drugs with sedating effects while taking this drug. b. **Substance P antagonists** e. Action: reduce or prevent immediate and delayed nausea and vomiting by blocking the substance P/neurokinin 1 receptors in the CTZ, preventing both substances from binding to and triggering the CTZ f. Side effects: Fatigue, diarrhea, headache, dizziness, mild hiccups, flatulence, and sweating. g. Adverse Effects: : Neutropenia, angioedema, severe allergic reactions, respiratory depression, anemia. Thrombocytopenia h. Nursing implications and patient teaching xi. Always double-check doses of substance P/neurokinin 1 receptor agonists because protocols vary according to the potential of the chemotherapy drugs to cause nausea and vomiting. More emetogenic chemotherapy drugs may require more frequent dosing. xii. In some cases this drug may be combined with a corticosteroid to reduce symptoms of nausea and vomiting even further. xiii. To prevent side effects, avoid alcohol and any sedating drugs while you are taking these drugs. xiv. Do not take any over-the-counter (OTC) or herbal drugs without checking with your healthcare provider or pharmacist because drugs from this category can interact with other drugs c. **Phenothiazines (dopamine antagonists)** i. Action: reduce nausea and vomiting by blocking dopamine (D2) receptors in the CTZ. j. Side effects: drowsiness, blurred vision, dry mouth, and dizziness. Some phenothiazines can cause urine to change to a pinkish red color. Sensitivity to sun exposure k. Adverse Effects: tardive dyskinesia, acute dystonia, and neuroleptic malignant syndrome, blood abnormalities, angina, tachycardia, and/or orthostatic hypotension. l. Nursing implications and patient teaching xv. Teach patients to change position slowly because these drugs can cause orthostatic hypotension. xvi. IM injections should be given deeply into large muscle. xvii. Remind patients that alcohol may increase drowsiness and risk of injury. xviii. Watch carefully for side or adverse effects related to these drugs and their effects on dopamine. Contact the healthcare provider for any Parkinson\'s disease--like tremors or gait changes, muscle spasms, or changes in motor movement such as tongue rolling or lip smacking because these are serious adverse reactions. xix. Monitor the patient carefully for any sudden increase in temperature because this can be an indication of neuroleptic malignant syndrome, a rare but life-threatening adverse effect. xx. You may experience dizziness, drowsiness, or blurred vision while taking this drug xxi. Change position slowly to avoid dizziness. xxii. Do not drink alcohol while taking this drug. Alcohol may increase the side effects. xxiii. You may notice a slight change in the color of your urine to a pinkish red. This is an expected side effect. xxiv. If you have any muscle spasms (particularly of the neck muscles); involuntary movements of the face, tongue, or upper or lower extremities; or any unusual restlessness, notify your healthcare provider immediately. xxv. Avoid becoming overheated during physical activity or very hot weather. xxvi. For relief of dry mouth, try sugarless gum or candy, or use ice chips to moisten your mouth. xxvii. These drugs can cause your skin to be more sensitive to light, so avoid direct sunlight and, if needed, wear protective eyewear and clothing. Wear sunblock while outside to avoid sunburn. d. **Cannabinoids** m. Action: natural or synthetic forms of THC that reduce nausea and vomiting by binding to cannabinoid receptors in the CTZ and by preventing serotonin 5-HT3 from binding to its receptors in the CTZ. n. Side effects: high feeling, dizziness, anxiety, insomnia, difficulty concentrating, and mood changes, emotional lability (wide swings in emotions), n/v, abdominal pain o. Adverse Effects: Acute confusion, hypersensitivity, and seizurelike activity p. Nursing implications xxviii. Cannabinoids are typically reserved for patients who continue to have nausea and vomiting that does not respond to other antiemetics. xxix. These drugs are typically given as an oral solution or in liquid-filled capsules with the dosage individualized according to body surface area calculations (e.g., a person who is 6 feet tall and weighs 225 pounds would receive 11.2 mg of the drug). The dosage is determined by the healthcare provider in conjunction with the pharmacist. xxx. For liquid drugs, always use the proper measuring device (e.g., oral syringe) to ensure accuracy. xxxi. The first dose should be taken on an empty stomach 30 minutes before a meal. After the first dose, these drugs can be taken with food. xxxii. Advise patients to avoid alcohol, sedatives, and other CNS depressants because they may increase the risk of sedation. xxxiii. Monitor the patient carefully for changes in mental status. Cannabinoids can cause confusion, sedation, and sometimes feelings of euphoria or a "high." These responses typically decrease after a few days of use. xxxiv. Avoid using alcohol, sedatives, or any antianxiety drugs with these drugs without talking to your healthcare provider. xxxv. Take the dose as prescribed; do not increase it without talking to your healthcare provider. xxxvi. This drug may cause you to feel slightly "high," xxxvii. Do not drive, operate heavy machinery, or participate in important decision making while taking this drug. xxxviii. Ask family members to stay with you when you first start taking the drugs in case you have some confusion or dizziness. e. **Promotility drugs (prokinetic drugs)** q. Action: increase contraction of the upper GI tract, including the stomach and small intestines, by blocking dopamine (D2) receptors in the CTZ and the intestinal tract. r. Side effects: drowsiness, fatigue, restlessness, visual impairment, urinary incontinence, and insomnia. s. Adverse Effects: depression and suicidal ideation, seizures, blood disorders, cardiac dysrhythmias, and heart failure. Symptoms similar to Parkinson's disease. t. Nursing implications: xxxix. Monitor the patient carefully for any mood changes or restlessness because these are common side effects. xl. Check vital signs regularly to assess for changes in blood pressure (decrease) because there is a risk of orthostatic hypotension. xli. Give these drugs at least 30 minutes before meals and at bedtime because these are times of increased potential for nausea. xlii. Avoid driving, using heavy machinery, or making important decisions while using this drug until you are aware of the effects. xliii. do not drink alcohol while taking this drug. xliv. If you have any depression or thoughts of suicide, notify your healthcare provider immediately. xlv. Inform your healthcare provider immediately if you have any sudden increase in fever, muscle spasms, or difficulty with movement because these may be signs of a more serious health issue. xlvi. Some men may experience erectile dysfunction or gynecomastia (enlargement of the breasts); some women may experience menstrual irregularities. These effects are usually reversible within a few weeks to a few months. 1\. Learning Step / Activity 1. Drugs for Peptic Ulcer Disease and Gastroesophageal Reflux Disease a. **Antacids** xlvii. Action: Neutralizes stomach acids to help relieve heartburn and indigestion. xlviii. Side effects: brands with magnesium can cause diarrhea; brands with calcium or aluminum can cause constipation xlix. Adverse Effects: Loss of appetite, frequent burping, nausea and vomiting, fatigue, and weight loss l. Nursing implications and patient teaching: 1. Antacids are often available as combination drugs, so review drug information carefully before giving. 2. Patients with heart failure or other cardiac diseases should avoid antacids that are high in sodium 3. Antacids neutralize gastric acids and are typically most beneficial if given between meals and at bedtime. 4. Take the drug exactly as prescribed. Antacids are generally taken 1 hour after meals and before bedtime. 5. If you are taking other drugs, it is usually best to take them 1 hour before or 2 hours after taking the antacid. Consult your pharmacist or healthcare provider if you have any questions. 6. Diarrhea and constipation are common side effects of different antacids. Contact your healthcare provider if they are severe. 7. To avoid adverse effects, never take more than the recommended amount. 8. Antacids are used for short-term treatment only; they do not prevent future attacks. 9. If you are taking a chewable antacid, chew it thoroughly before swallowing, and take it with a full glass of water. 10. Shake any liquid antacid well before taking it, to ensure that the dosage is correct. b. **Histamine H2-Receptor Blockers** i. Action: Bind to the H2 receptors in stomach cells, which decreases production of basal and nighttime gastric acid. They also decrease the amount of gastric acid that is released with meals and substances such as caffeine ii. Side effects: headache, nausea, diarrhea or constipation, mild abdominal pain, mental status changes, including confusion, anxiety, or depression. iii. Adverse Effects: severe allergic reactions, a variety of blood disorders, and cardiac dysrhythmias iv. Nursing implications and patient teaching: 1. Patients who are taking OTC histamine H2-receptor blockers should not take them for more than 2 weeks without seeing a healthcare provide 2. Monitor the patient for signs of restlessness or confusion because these side effects may increase the risk for falls. 3. Once-daily dosing of H2-receptor blockers is best at bedtime to reduce symptoms of acid reflux at night. 4. Avoid cigarette smoking because it increases gastric acid production and can decrease the effectiveness of H2-receptor blockers. 5. Take H2-receptor blockers only for occasional episodes of heartburn because they can lose their effectiveness. If symptoms continue, contact your healthcare provider for diagnosis and treatment. 6. Do not drive or operate heavy machinery until you see how the drug affects you. These drugs may cause dizziness in some people. 7. Use handrails when you are using stairs in case you have any dizziness. 8. Ask your family members to observe you for any changes in mental status, such as confusion or anxiety and depression. c. **Proton-Pump Inhibitors** v. Action: Helps to heal gastric ulcers and reduce symptoms of GERD by stopping the acid secretory pump that is located in the gastric parietal cell membrane, which reduces the amount of acid secreted into the stomach. vi. Side effects: headache, mild abdominal pain, nausea and vomiting, flatulence (passing gas), and diarrhea or constipation, photosensitivity, dizziness, anxiety, and mild rash, Low vitamin B12 levels. vii. Adverse Effects: severe allergic reactions, pancreatitis, and blood abnormalities including thrombocytopenia and hemolytic anemia, C. Diff, low magnesium and iron levels, and chronic kidney disease, high risk for osteoporosis. viii. Nursing implications and patient teaching: 9. Give with a full glass of water 30--60 minutes before the first meal of the day for maximum benefit. Read drug information carefully. 10. OTC PPIs should not be taken for more than 2 weeks because failure to relieve symptoms may indicate a more severe health problem. 11. PPIs may be prescribed for 2 to 8 weeks depending on the patient\'s presenting condition. 12. Teach patients that it may take several days to experience relief after beginning a PPI. 13. if the patient has H. pylori bacteria in the stomach, the PPI will be combined with specific antibiotics to treat the infection. Remind the patient to take the full prescription. 14. Avoid driving or using heavy machinery while taking this drug because it may cause dizziness. 15. Contact your healthcare provider for recommendations about calcium and vitamin D because this drug can increase your risk of osteoporosis. 16. Do not use OTC PPIs for longer than 2 weeks. If symptoms continue, contact your healthcare provider. 17. If you are taking prescription PPIs, take the full prescription even if you feel better. 18. These drugs do not cure ulcers, but they do reduce acid in your stomach so that the ulcer can heal. 19. Wear sunscreen and protective clothing because your skin may be more sensitive to light d. **Cytoprotective Drugs** li. Action: protects the lining of the stomach and prevent further damage lii. Side effects: liii. Adverse Effects: liv. Nursing implications and patient teaching: 11.  Do not give antacids within 30 minutes before or 1 hour after sucralfate because they decrease the drug\'s effectiveness. 12. Do not crush or chew the tablets. 13.  shake the oral suspension well before giving it. 14. If patients do not receive relief from the recommended doses, make sure to contact the patient\'s healthcare provider. 15. Teach patients that bismuth subsalicylate can turn stools dark brown or black while taking the drug. 16. Taking too much bismuth subsalicylate can result in symptoms of aspirin toxicity because of the salicylate components of the drug. 17. Encourage the patient to drink at least 2--3 L of liquid daily unless contraindicated because this drug can cause constipation. 18. Remember that misoprostol must never be given to pregnant women because it can cause uterine contractions.**\ ** 1\. Learning Step / Activity 1. Antidiarrheals a. Anticholinergic Drugs i. Action: reduce diarrhea and associated symptoms by selectively blocking the neurotransmitter acetylcholine from binding to its receptors in nerve cells. The nerve fibers of the parasympathetic system affect the involuntary movement of smooth muscle in the GI tract, lungs, and urinary tract. ii. Side effects: nausea, vomiting, dry mouth, and constipation. Other side effects are dizziness and drowsiness. iii. Nursing implications and patient teaching: 1. Do not give this drug within 2 hours of giving an antacid 2. Do not stop this drug suddenly if the patient has used it for a long time. Sudden stopping of the drug may cause withdrawal symptoms, including dizziness, sweating, and vomiting. 3. To avoid local skin reaction with local pain and edema, inject this drug into a large muscle mass. b. Antispasmodic drugs iv. Action: reduce muscle contraction in the GI tract, which causes decreased cramping, bloating, and diarrhea. v. Side effects: nausea, vomiting, dry mouth, and constipation. Other side effects are dizziness and drowsiness vi. Nursing implications and patient teaching: 4.  Teach patients that they should not use contact lenses while taking these drugs because they can cause dry eyes and blurred vision. 5. These drugs decrease GI motility and should not be used for infectious diarrhea. 6. Monitor the patient\'s vital signs carefully because these drugs can cause significant changes in heart rate (bradycardia or tachycardia). 7. These drugs are not recommended for older adults because they can cause confusion and other adverse effects even at low doses. 8. See nursing implications for anticholinergic drugs; these drugs contain atropine, which is an anticholinergic drug. c. Synthetic opioid agonists vii. Action: block mu-opioid receptors in the gut and decrease motility of the smooth muscle of the bowel. They are combined with atropine to decrease the mood-elevating effects of the opioid and reduce the potential for abuse viii. Side effects and Adverse effects: Opioid agonists may interact with other opioid drugs to increase the opioid effect nausea, vomiting, dry mouth, and constipation. Other side effects are dizziness and drowsiness ix. Nursing implications and patient teaching: 9. Remind patients to avoid sedatives, tranquilizers, and opioid pain drugs because they may increase the risk of CNS effects. 10. Teach patients to follow directions carefully because overuse can result in constipation. 11. Drugs with atropine may cause side effects such as dry mouth or blurred vision. Use caution when taking the drug. Patients may find that ice chips or sugar-free candy may help keep their lips and mouth moist. 1\. Learning Step / Activity 2. Drugs for Constipation d. Bulk-forming drugs x. Action: absorb fluids in the GI tract, forming a mixture that leads to softening and increased bulk of the stool. The increased bulk stimulates peristalsis, resulting in increased bowel mobility and more rapid transit time through the GI tract. Stools are easier to pass. These drugs also help patients with watery diarrhea by increasing the bulk and consistency of the stool. xi. Side effects: Abdominal cramping, nausea, vomiting xii. Adverse Effects: Bulk-forming laxatives are the safest laxatives. Nevertheless, inhaling psyllium dust particles can cause hypersensitivity reactions. These reactions can be as severe as bronchospasm and anaphylaxis. Risk for obstruction. xiii. Nursing implications and patient teaching: 12. Teach patients that these drugs typically work within 12 hours to 3 days. 13. Instruct patients to drink at least one full glass of water with each dose to avoid blockages in the esophagus. 14. These drugs can be mixed with water, fruit juices, or milk for better flavor. e. Emollients/stool softeners xiv. Action: lower the surface tension of the stool, allowing water and lipids to permeate it. The stool is softer and easier to pass. It typically takes 1 to 3 days for the patient to receive benefit. xv. Side effects: Mild abdominal cramping, nausea, cramps, throat irritation, rashes; with some stool softeners, urine can have a color change varying from pink-red to yellow-brown depending on the acidity of the urine Abdominal cramping, hyperemia (increased blood flow) of rectal mucosa, rectal discomfort xvi. Adverse Effects: stool softeners rarely cause adverse events; however, severe allergic reactions are possible ay decrease absorption of nutrients and fat-soluble vitamins. Rarely, a condition called lipid pneumonia can result from inhalation of fat-containing substances such as mineral oil xvii. Nursing implications and patient teaching: 15.  Teach patients that they may experience a change in urine color from pinkish red to yellow-brown, depending on the alkalinity or acidity of the urine. 16. Teach patients that these drugs typically have an effect in 1--3 days. They are not used to treat acute constipation but to prevent constipation from occurring. f. Stimulants xviii. Action: stimulate peristalsis by irritating the mucosal lining of the intestine, and they increase the amount of fluid in the intestine, relaxing the bowel and easing the passage of stool. xix. Side effects: Abdominal cramps, diarrhea, hypokalemia (low potassium), muscle weakness, nausea, rectal burning xx. Adverse Effects: may produce muscle weakness (after excessive use), dermatitis, pruritus, alkalosis, and electrolyte imbalance (with excessive use). xxi. Nursing implications and patient teaching: 17. These drugs are available over the counter and may be used for occasional constipation. Higher doses can be used as bowel preparation for x-rays of the colon or for colonoscopy. 18. Inform patients regarding the expected onset of action. Oral tablets can work within 6--12 hours; rectal suppositories can work within 15 minutes to 1 hour g. Osmotic laxatives xxii. Action: increase fluid absorption by the stool. As a result, the stool is softer and distends the colon, leading to peristalsis and easier passage of the stool xxiii. Side effects: 19. lactulose (Cephulac, Cholac, Constilac) - Abdominal distention, belching, diarrhea, flatulence, GI cramps, hypoglycemia in patient with diabetes 20. lubiprostone (Amitiza)-Abdominal pain and distention, diarrhea, dizziness, dry mouth, gas, headache, nausea, peripheral swelling, reflux 21. magnesium hydroxide (Phillips\' Milk of Magnesia) Diarrhea, flushing, sweating 22. polyethylene glycol (MiraLAX)- Abdominal bloating, cramping, flatulence (gas), nausea 23. sodium phosphate (Fleet Enema) - Abdominal bloating, abdominal pain, dizziness, electrolyte imbalances (hyperphosphatemia, hypocalcemia, hypokalemia, sodium retention), GI cramping, headache, nausea, vomiting xxiv. Adverse Effects: can produce a fluid and electrolyte disturbance if used daily or in patients with renal or cardiac impairment xxv. Nursing implications and patient teaching: 24. Follow directions very carefully when these drugs are used as part of bowel preparation for colonoscopy or other procedures. Protocols may vary between prescribers. The goal is to have the best visibility of the lower intestine during the examination. 25. Instruct patients not to use these drugs more than recommended to avoid severe fluid and electrolyte imbalance. 26. Some preparations include high amounts of sodium, and they should be avoided in patients who require a low-sodium intake. 27. These drugs work very quickly, with onset of action within 1--3 hours. Teach patients that they should be near a place that has a bathroom or commode available. General Patient and Family teaching a. Drink a full glass of fluid with each dose of bulk-forming laxative to avoid blockage in the esophagus. b. Most laxatives are recommended for short-term use only. Contact your healthcare provider if you require laxatives on a regular basis or do not have relief with the OTC drugs. c. Some laxatives are high in sodium or sugar. Read the labels carefully if you are on a low-sodium diet or have diabetes. d. Laxatives are not a substitute for good bowel habits, including regular physical activity and a diet that includes high-fiber foods such as whole grains, fruits, and fresh vegetables. e. Many types of drugs increase the risk of constipation. If you are taking a drug that causes constipation, contact your healthcare provider to determine the best type of laxative for you. f. Never take a laxative to treat severe abdominal pain because the drug may cause conditions such as appendicitis or diverticulitis that make the pain worse. g. The onset of action of laxatives varies according to the specific drug category. These drugs can work in as soon as 1 hour or as long as 2 to 3 days. Knowing the expected time of onset will help you plan. 1\. Learning Step / Activity 1. Pharmacological Calculations. a\. Ratio and Proportion: before the ratio and proportion method can be used to solve pharmaceutical calculation problems, there are three conditions which must be met. \(1) The numerators must have the same units. \(2) The denominators must have the same units. \(3) Three of the four variables must be known. \(4) Example Problem: \(a) First, find the [expression of strength]. \(b) Next, assign the third known value. \(c) Then, assign \"X\" to the unknown value in the second proportion. **\*\*NOTE\*\***Check to make sure the units correspond. **\*\*NOTE\*\***Many errors occur because of the failure to label problems with units of measurement. Labeling with units will insure that the corresponding units of the proportion are the same. \(d) Solve the proportion by using the following four step method. 1\) Cross multiply. 2\) Convert to an algebraic equation. 3\) Solve for \"X\". 4\) Refer back to Step 1 to find the unit of measurement for \"X\". The answer is [incomplete] without a unit of measure. b\. Formulas can be used when calculating doses in the same system of measurement. \(1) When the dose desired and the dose on hand are in different systems, convert them to the same system before using the formulas. \(2) Formula: [D] x Q = *x* H \(a) D = the dose desired, or what the doctor has ordered. \(b) H = the dose strength available, what is on hand. \(c) Q = the quantity or the unit of measure that contains the dose that is available. \(d) *x* = the unknown, the dose you are looking for, the dosage you are going to administer. \(1) Metric System: \(a) Fractional metric units are expressed as a decimal. \(b) Place a zero in front of the decimal point when the quantity is less than a whole number to prevent potential dosage error. \(c) Omit trailing zeros to avoid misreading of a value and potential error in dosage. \(d) Abbreviation for a measure is placed after the quantity. \(e) Place a space between the numeral and abbreviation. \(f) Milliliters, micrograms, milligrams, grams, and kilograms: 1\) Milliliters (mL): carry to 3 decimal places and round to hundredths (0.01). 2\) Micrograms (mcg): carry to 3 decimal places and round to hundredths (0.01). 3\) Milligrams (mg): carry to 3 decimal places and round to hundredths (0.01). 4\) Grams (gm): carry to 3 decimal places and round to hundredths (0.01). 5\) Kilograms (kg): carry to 2 decimal places and round to tenths (0.1). \(2) Apothecary System: \(a) Abbreviation or symbol is placed before the quantity. \(b) System uses fractions, Roman numerals and Arabic numerals. \(c) When possible, convert apothecary and household measures to metric measures. \(3) Converting Within and Between Systems: \(a) Regardless of the method used for converting, memorizing equivalents is a necessity. \(b) Answers stated in fraction format should be reduced as necessary. \(c) Division should be carried out two decimal places to ensure accuracy and it is not rounded. \(4) Conversions: \(a) When converting between Fahrenheit and Celsius, if necessary, carry the math process to hundredths and round to tenths. \(b) Converting Pounds to Kilograms: 1\) Equivalent: 2.2. lb = 1 kg 2\) To convert lb to kg divide by 2.2 (think: larger to smaller). 3\) Answer is rounded to the nearest tenth. \(c) Converting Kilograms to Pounds: 1\) Equivalent: 2.2 lb = 1 kg 2\) To convert kg to lb multiply by 2.2 (think: smaller to larger). 3\) Answer is rounded to the nearest tenth. \(5) Oral Medications: \(a) Tablets / Capsules: 1\) When the precise number of tablets or capsules is determined and you find that administering the amount calculated is unrealistic or impossible, always use the following rule to avoid an error in administration: no more than 10% variation should exist between the dose ordered and the dose given. Thus, if 0.97 tablet / capsule should be given, you could give 1 tablet / capsule. 2\) Capsules are not scored and cannot be divided. They are administered in whole amounts only. 3\) When different strengths of tablets and capsules are available for administration, the best combination of tablets or capsules to give, would allow the least number of tablets or capsules without breaking a tablet. 4\) Breaking an unscored tablet in portions smaller than halves usually does not yield an accurate dose. 5\) The maximum number of tablets or capsules given to a patient is usually three. ***[Remember:]*** except for special medications, any more than three capsules or tablets to achieve a certain dosage is unusual and may indicate an error in interpretation of the order, transcription, or calculation. **Think! Always question any order that exceeds this amount.** 6\) Tablets are rounded to the nearest HALF or WHOLE. 7\) Capsules are rounded to the nearest WHOLE NUMBER. \(b) Liquids: 1\) Read labels carefully, identify the dosage strength contained in a certain amount of solution. 2\) Dosage strength on solutions can be written several ways, do not confuse it with total volume. 3\) Oral liquids are rounded to the nearest tenth (0.1). \(6) Parenteral Medications: \(a) Syringes: 1\) Standard Insulin syringe is calibrated by 2 U increments. Used to administer insulin only. 2\) 1 mL (TB) calibrated to measure 0.01 mL accurately. Used to administer dosage \< 0.5 mL. 3\) 3 mL calibrated to measure 0.1 mL accurately. Used to administer medication volumes \> 1 mL. 4\) Larger volume calibrated to measure 0.1 or 0.2 mL increments. 5\) Dosages involving mL should be expressed as decimals even when the syringe is marked with fractions. \(b) Injectables are rounded to the nearest tenth (0.1), [EXCEPT] Heparin, Insulin and Terbutaline; these are rounded to the nearest hundredth (0.01). 1\) \< 1 ml: carry to (thousandths) 3 decimal places and round to 2 (hundredths). 2\) \> 1 ml: carry to (hundredths) 2 decimal places and round to 1 (tenths). 3\) U100 means 100 units / mL. \(7) Reconstitution of Powered Medications: \(a) Information needed to work problems: 1\) Type and amount of diluents. (***NEVER ASSUME!***) 2\) Dosage strength of the mixed medication. 3\) Length of time the solution will remain stable. 4\) Storage information. \(8) Intravenous Medications: \(a) Rates (gtts/min or ml/hr) are rounded to the nearest whole number. \(b) When IV medications are diluted for administration, medication volume will added to the total volume of the IV bag. \(c) IV infusion rates: whole numbers only: drops/min or mL/hr. ***[DO NOT ROUND WITHIN A CALCULATION PROBLEM UNTIL THE END, EXCEPT FOR KG/LB.]*** ----------- ------------------------------------------------------------------ **NOTE:** Conduct a check on learning and summarize the learning activity. ----------- ------------------------------------------------------------------