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# Pharmacy Technician - PowerPoint PPT Presentation

Pharmacy Technician. Math Module. Calculate the Dosage.

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### Pharmacy Technician

Math Module

Ashia is a pharmacy technician at a local hospital. She works part time to support her family and provide health insurance coverage for her family. She prefers to work evenings when her husband can assist her by watching their two children.

Hi,

my name is Ashia; I am a pharmacy technician.

The focus of this math strand is for you to be able to figure out the amount of medication, in the proper form, to fill a prescription ordered by a doctor.

In this math strand, you will be learning and reviewing the following math skills:

1) Applying medical abbreviations to math solutions2) Using a formula to calculate dosage3) Adding4) Multiplying5) Dividing6) Sorting necessary and unnecessary information to solve a word problem7) Noting key math words or phrases to solve math problems such as simplify an expression and per as in 5 milligrams per milliliter8) Reading drug labels9) Applying the standard formulas used in health care

On the evening shift,Ashiasupports the nursing staff at the hospital by calculating medical dosages and providing the medicine in measured doses to the nursing staff. To do this, Ashia relies on some basic knowledge about medications.

The dose is located directly after the name of the medication. This is the individual dose that the doctor is ordering. The total medication order covers a certain period of time such as: take for 7 days, take for 10 days, or take daily. Look at the doctor’s prescriptions and consider the following questions:

Phone 360-293-9999 DEA# 23476512

Angela Truong, MD

Pediatrician

Pt. name Thi Tran Age12 Date May 1, 2008

Address: 234 7th Avenue, Anacortes, WA 98221

RX Ceclor 10 mL bid X 10 d

Refill _0_ _X_Generic and/orequivalent allowed

Physician’s Signature Angela Truong

Anacortes Pediatric Medical Office

23453 Mall Blvd.

Anacortes, WA 98221

3) How many times a day is this medication to be given? Click Here

Ceclor

10 milliliters twice a day

For 10 days

Listen and read along as Aisha defines medical order and prescription.

Did you know that a medical order or medication order is a drug order written in a hospital, nursing home, or recovery center for a patient? A prescription is a drug order that is written in an office or clinic or for a client or patient being discharged. Licensed medical personnel like physicians, nurse practitioners, and other certified practitioners are allowed under state law to write medical orders and prescriptions.

A doctor writes a prescription or drug orders for patients. Again, a prescription is a written medication order for a patient leaving a medical facility. A medical order is used in a hospital or care facility. For example, a patient in the hospital may have a change in medication or need to have an increase or decrease in the amount of medication. Both of these medical prescriptions follow a similar format and include the essential information that the pharmacy technician or other licensed health care workers will use to fill the order. Please note that the paper forms of prescriptions and medical orders do not all look the same; however, the information is the same. This information may be in a different location on the form.

Safety Alert: A pharmacy technician may fill the drug order and work under the supervision of the pharmacist. The pharmacist will check and verify the accuracy of each filled prescription before handing it to the patient or client.

Look at the general format of a prescription.

Do you ever look carefully at your prescription before you hand it to the pharmacist or pharmacy technician to fill? You should so that you know what medicine you are getting and the amount. You can also ask the pharmacist questions about what the doctor has prescribed. The job of a pharmacy technician requires careful reading. You need to read the prescription carefully to understand the medication ordered and then compare this drug order to the supply available on the pharmacy shelves.

_Phone_#_________ -DEA# 123456878

Thelma Cook, MD

2332 Medical Way

Renton, WA 98056

Pt. Name: ______________________ Age:__________

RX: ___________________________________________________________________

Refill: _____________

__________Generic and/or equivalent allowed

___________________________________Date______

Physician’s Signature

As a pharmacy technician, you need to read the prescription carefully; otherwise, you may not select the correct medicine to fill the bottle. This is especially true because many medications have similar names and often times a particular medication comes in several forms. The form of medication must match the route, or way, that the medication will be taken. For example, an elixir is a liquid and easily swallowed by a young child. An older adult may take the medication in tablet or capsule form.

As a patient, you should check the number and type of medicine you get from the pharmacy to make sure that it matches what the doctor ordered.

What information is included on the prescription?

Why do you think that this information is important to the pharmacist?

The prescription contains:

a) The patient’s or client’s full nameb) The datec) The drug name d) The doctor’s order for dosage amount (how much medication)e) The administration route (by mouth, IV, injection)f) The frequency with which the patient is to take the medicationg) The duration, the number of days that the patient is to take the medicationh) The quantity or amount that the pharmacist is to dispense. i) A check off or box allowing a substitutej) The physician’s signaturek) The physician’s DEA number (United States Drug Enforcement Agency registration number) if the medication is a controlled substance such as morphine or codeine

The medical community requires that all prescriptions contain certain information. This is to avoid making medical errors. Again, the information is not required to be in the same format or placed in the same area on the prescription form. Thus, there is no single form for medical orders and prescriptions.

Here are the eleven items of a prescription:

a) The patient’s or client’s full nameb) The datec) The drug name d) The doctor’s order for dosage amount (how much medication)e) The administration route (by mouth, IV, injection)f) The frequency with which the patient is to take the medicationg) The duration, the number of days that the patient is to take the medicationh) The quantity or amount that the pharmacist is to dispense. i) A check off or box allowing a substitutej) The physician’s signaturek) The physician’s DEA number (United States Drug Enforcement Agency registration number) if the medication is a controlled substance such as morphine or codeine

Can you locate all eleven parts of the prescription?

Phone 425-235-9999 DEA# 123456878

Thelma Cook, MD

Pt. name Bruce BrownAge50Date April 29, 2008

Address: 12347 NE 2nd Street, Seattle, WA 98432

RX Darvon 1 g tab. p.o.q4 h.for 3 days

Refill _0_ ___Generic and/or equivalent allowed

Physician’s Signature ________________Thelma Cook

546 North Street

Seattle, WA 98045

Print, and fill in the chart with the information from the prescription:

Practice locating the eleven parts of the medical order or prescription. Complete your chart, and then compare it with the answers on the next screen.

Phone 360-456-9999 DEA# 44567823

Buck Sawyer, MD

Pediatrician

Pt. name Sammie Smith Age12 Date May 1, 2008

Address: 546 4th Avenue, Everett, WA 99876

RX Loratidine 5 mg tabletsqd X 5 d

Refill 1_ _X_Generic and/or equivalent allowed

Physician’s Signature ________________Buck Sawyer

Everett Pediatric Medical Office

23453 Mall Blvd.

Everett, WA 99876

Read the prescription and then complete the chart below, complete your chart, and then compare it with the answers on the next screen.

Phone 206-777-9999 DEA# 98072653

Yu Thi Nguyen, MD

Gerontology

Pt. name Ethyl BonkerAge98 Date May 5, 2008

RX acetaminophen 650 mg. tablets po. q 4h x 5 d

Refill _2_ _ _Generic and/or equivalent allowed

Physician’s Signature ________________NguyenYuThi

Capitol Hill Senior Medical Center,

3000 Broadway N., Seattle, WA 98045

Read the prescription and then complete the chart below, complete your chart, and then compare it with the answers on the next screen.

Phone 206-333-8888 DEA# 34455667

Pt. nameMohamed SomaAge 32

Address: 23234 Ballard Ave E., Seattle, 98567

RX Pencillin-G 2 million U IM qid X 7 d

Refill _0_ _ _Generic and/or equivalent allowed

Physician’s SignatureAretha Arnold, MDDate May 2, 2008

Aretha Arnold, MD

Infection Specialist

North Central Medical Center,

23 Antioch Way N., Seattle, WA 98655

scored tablet

Listen and read along as Aisha discusses scored tablets.

Did you know that only tablets that are scored may be split in half? What is a scored tablet? A tablet that is scored has a cut where it may be divided. It is important to know that the only scored tablets are divided along the score line to ensure an even distribution of medication. Enteric-coated tablets, those tablets with a special coating over the medicine, are not divided because they are coated with a special substance that allows them to dissolve in the intestines instead of the stomach. Dividing a tablet also impacts its absorption. Capsules (two-part soft tablets) and suppositories (medicine capsules inserted into the rectum) are never divided because the medicine needs to remain coated when it enters the body and even distribution of medication may be a problem

1. C 2. D 3. E 4. B 5. A

Why do some drugs come in different forms?

How do you know what form it comes in?

Drugs come in different forms because there are many different kinds of patients. For example, babies do not swallow tablets so there are injections, liquids, and suppositories. Adults can swallow tablets and capsules. Also, different administration routes have different absorption rates, or the medicine form determines how quickly it will become effective. For example, a tablet takes longer to work in the body than an injection. An injection goes into blood stream quicker. A tablet must be absorbed through the stomach and that takes time.

Read the prescription or medical order. Note that g or mg or mcg is a dry weight and so these are tablets, capsules or suppositories. Milliliters and units (a special unit of measure used in medicine) are volume or liquid measures, which could be elixirs or injections.

Task Two: Understanding the Parts of the Dosage Formula

The dosage formula has four parts. We use this formula to translate a doctor’s order so that a pharmacy technician can calculate an individual dose for a patient.

Why would a formula assist a pharmacy technician to calculate a drug dosage?Click Here

Do you think that a formula can help sort out the parts of a word problem? Click Here

Yes, because the quantities represented in the formula go in the same place in the math equation. Pharmacy technicians learn how to read the prescriptions and substitute the information into the dosage formula.

A formula is an agreed upon method of calculating dosages in the same way so that the dosages are equivalent (or equal).

Let’s look at the parts of the dosage formula.

Let’s look more closely at the parts of the dosage formula.

Another part of the prescription to know about is the medical terms used to detail the doctor’s order.

To calculate an individual drug dosage, we use a formula. Patients have individual dosages and daily doses. The formula is used to calculate an individual or one time dose. The daily dose has to do with the frequency of a dose.

qd = every day every 8 hours

bid = twice a day at hs = hour of sleep

tid= three times a day prn = as needed

qid = four times daily

Note that time does not play a role in calculating the individual dose. The factors are the doctor’s order for an amount of drug, the form of the medication available in the pharmacy, and the form of the medication (tablet, capsule, mL).

Aisha is often asked to describe how much a gram, milligram, and a microgram weigh. She shows the clients this chart to show the relationship among these common metric units of measure.

In the metric system, the answers will be either whole numbers or decimals. No fractions are used in the metric system. For example: 2.75 grams or 1.2 milliliters or 0.5 micrograms.

Also, any decimal number that is not greater than 1 has a 0 in front. So the correct form is 0.8 mL instead of .8 mL.

1. G2. H3. I4. J5. F6. A7. C8. K9. L10. D11. B12. E

Use the formula to practice substituting the information from the prescription into the formula.

ddhh x q = individual drug dose

Safety Alert: The quantity is important to know because it leads the pharmacy technician to the correct form or unit of measure for a specific drug. In other words, if the quantity (q) is a tablet, the individual dose will be in tablets. If the quantity is in milliliters, the pharmacy technician knows that the medication is in liquid form. Including the quantity in the formula, helps ensure proper form of the medication. Young children would take medication in a liquid form while adults may take a tablet or capsule.

Let’s put Aisha’s task together and see the medication vial and the prescription and learn how they are the tools of the pharmacy technician.

Rx: Doctor Sheila Smith orders 30 mg of Augmentin for his patient.

Ashia, a pharmacy technician, looks at the drug label and discovers that the medicine is supplied in 60 milligrams per tablet.

RX30 mg Augmentin

Dr. Sheila Smith 4/6/08

60 mg

Practice setting up the problems. Do not work the problems yet.

(d) 30 mg x (q) 1 tablet = drug dose(h) 60 mg

1) Order: 500 mg Supply on hand: 250 mg per tablet

2) Order: 1000 mg Supply on hand: 2000 mg per scored tablet

(d) 500mg x (q)1 tablet = drug dose

(h) 250mg

(d) 1000mg x (q)1 tablet = drug dose

(h) 2000mg

3) Order: 1 gSupply on hand: 12. gr per capsule

4) Order: 50 mg Supply on hand: 25mg per 5 mL

5) Order: 500 mg Supply on hand: 125mg per caplet

(d) 1gr x (q)1 capsule= drug dose

(h) ½ gr

(d) 50mg x (q) 5mL= drug dose

(h) 25mg

(d) 500mg x (q) 1 caplet= drug dose

(h) 125mg

Task Three: Calculating the Dosage Formula

To calculate a doctor’s drug order (how much medication is needed for an individual dose), we use a formula.

Review: Remember that the fraction bar means to divide.

There are two ways to look at calculating this formula.

Method 1: Multiply d (doctor’s order) times q (format of the medicine on hand) then divide the result by h (supply on hand).

The doctor orders 250 mg of a medication. Aisha has the medication in 125 mg per capsule in her pharmacy’s supplies.

250mg125mg x 1 capsule = _________

a) 250 x 1 = 250 b)250 ÷ 125 = 2

Thus, the answer is 2 capsules, but it is a bad habit to get into,  if it wasn’t a 1 in the quantity you’d get an incorrect answer.

Method 2: Divide d (the doctor’s order, the numerator, or top number) by h (the supply on hand, the denominator, or bottom number) then multiply by q (the format of the medicine on hand).

The doctor orders 250 mg of a medication. Aisha has the medication in 125 mg per capsule in her pharmacy’s supplies.

250mg125mg x 1 capsule = _________

a) 250÷125 = 2 b) 2 x 1 =2

Thus, the answer is 2 capsules.

One of the things to consider is the possibility of simplifying the expression before multiplying or dividing. For example, Aisha filled this prescription earlier in the day.

The doctor order 100 milligrams of a medication. The drug was available in 25 milligrams per 5 milliliters.

100mg 25mg x 5 milliliters = _________

100mg 100mg 25mg x 5  milliliters = 5 mg x 1milliliters = 100 5 = 20

Thus, the answer is 20. Notice since 5 divides evenly into 25, Aisha simplifies the expression before multiplying or dividing.

Practice simplifying expressions to be ready to work with Aisha.

5 mL

1.25 mL

20 mL

300mL

1.25 mL

31 mL

Aisha needs to fill the following drug orders for the evening shift nurses.

Assist her in the set up and the solutions of each medical order.

1) Ampillicin 500 mg p.o. qid X 5 d. Dosage available: 250 mg capsules. Click Here

______________ x __________ = ____________

2) Ordered Clondine 0.4 mg p.o. bid X 3 d. Dosage available: 0.1 mg tablets. Click Here

______________ x __________ = ____________

2 capsules

4 tablets

3) Prescribed: Tigan 200 mg IM q 8 h x 4 d for nausea. On hand: Single use vials 100mg/1mL. Click Here

______________ x __________ = ____________

4) Give: Digoxin elixir 150 mcg stat p.o. Dosage available: 50 mcg/mL. Click Here

______________ x __________ = ____________

5) Ordered: Codeine sulfate 60 mg p.o. q 4 h until further notice. Dosage available: 30 mg tablets. Click Here

______________ x __________ = ____________

2 milliliters or 2 mL

3 milliliters or 3 mL

2 tablets

Put the pieces together to complete the following medication orders as Aisha would.

Read the prescription, and look at the medication bottle. Then use the dosage formula (d/h x q) to calculate the drug order.

1.

Phone 206-344-8888 DEA# 98098766

Bertha Bolls, MD

Pt. name KumiKaurAge30 Date May 1, 2008

Address: 2349 Busy Ave E., Seattle, 98567

RX Lasik40 mg p.o. q 12 h x 4 d

Refill _0_ _Generic and/or equivalent allowed

Physician’s Signature Bertha Bolls, MD

South Central Medical Center,

34 Burlington Way N., Seattle, WA 98655

Supply on Hand

Lasix 20 mg tablets

2 tablets

Read the prescription, look at the vial, then calculate the drug order.

Phone 206-355-9999 DEA# 45632144

Richard Smalls, MD

Pt. name Brenda GuilianiAge44 Date May 1, 2008

Address: 65 Lake Drive E., Seattle, 98567

RX Ampicillin 250 mg p.o.qid x 10 days

Refill _0_ _ _Generic and/or equivalent allowed

Physician’s SignatureRichard Smalls, MD

Mid Central Medical Center,

64 Booth Garnder Way N., Seattle, WA 98655

Ampicillin

125 mg capsules

2 capsules

Read the prescription, look at the vial, then calculate the drug order.

Phone 206-888-9999 DEA# 546565651

Wing Hu Chi, MD

Pt. name Elsa Bridges Age23 Date May 7, 2008

Address: 45 Riveria Way, Seattle, 98567

RX Ampicillintrihydrate 250 mg p.o. qid x 10 days

Refill _0_ _ _Generic and/or equivalent allowed

Physician’s SignatureWing Hu Chi, MD

Lake View Medical Center,

54 Sealth Blvd. N., Seattle, WA 98655

Ampicillintrihydrate125 mg in 5 mL of syrup

10 milliliters or 10 mL

Task Four: Calculate daily doses and beyond

When Aisha is not filling individual medical orders, she often has a stack of other prescriptions to fill for her supervising pharmacist. She must prepare these for him to review for accuracy before they are bagged and binned for the customers to pick up at the pharmacy.

To do this she must correctly interpret the prescriptions, duration, and/or the number of individual doses that the doctor has ordered. This relies on her skills in addition and multiplication as well as her ability to read the prescription.

Why would a pharmacy technician need to be able to calculate a full prescription dosage?Click Here

Do you think that multiplication is the most efficient means to solve this problem? Click Here

To fill the complete prescriptions for clients. For example, clients do not go to the pharmacy on a daily basis. They go once to get the complete order filled.

Yes, multiplication is usually faster than adding the number over and over.

Let’s review an earlier prescription:

Phone 206-333-8888 DEA# 34455667

Pt. nameMohamed SomaAge 32

Address: 23234 Ballard Ave E., Seattle, 98567

RX Pencillin-G 2 million U IM qid X 7 d

Refill _0_ _ _Generic and/or equivalent allowed

Physician’s SignatureAretha Arnold, MDDate May 2, 2008

Aretha Arnold, MD

Infection Specialist

North Central Medical Center,

23 Antioch Way N., Seattle, WA 98655

The key to filling this prescription for the patient is to read the line: Penicillin-G 2 million U IM quidx 7 d.

Penicillin-G 2 million U IM quid x 7 d.

This translates to 2 million units 4 times a day x 7 days.

So to figure out the daily dosage:

a) 2 million units x 4 = 8 million units

b) To figure out 7 days’ dosage, multiply 8 million units x 7 days.

For 7 days’ supply, the pharmacy must have on hand 56 million units of Penicillin-G.

Help Aisha calculate the daily and the total prescription by days. Advance to the next screen for the answers.

1) Using a formula to calculate dosage

3) Multiplication

4) Division

5) Apply the standard forms used in health care

6) Sorting needed information from extra information in a word problem

Calculate

Simplify an expression

Per

Divide

Formula

Fraction

Gram

Milligram

Multiply

Milliliter

1) The doctor has ordered Zyloprim 0.25 g twice a day. The pharmacy has on hand: Zyloprim 0.1 g scored tablets. The patient will receive the following individual dose:_________________________ Click Here

2) Order: 75 milligrams of medication xAvailable: 25 milligrams in 2 millilitersGive: Click Here

3) Give Dilaudid1.5 milligram IM from a vial that is labeled 0.6 milligrams per milliliter. Give Click Here

4) Order: Zocor 40 milligrams; On hand: Zocar 20 milligrams per tablet. Give Click Here

2 ½ tablets

6 milliliters or 6 mL

2.5 milliliters or 2.5 mL

2 tablets

5) Dr. Mix prescribes Procardia XL 60 milligrams once daily. The drug on hand is Procardia XL 30milligram tablets. The patient will receive _________________________ Click Here

6) The physician orders Plendil 7.5 mg once a day in the morning. The drug label reads: Plendil (felodipine) 2.5 mg tab. Give Click Here

7) The doctor’s order is for 20 milligrams of a medication. You have 10 milligrams per 5 milliliters. The dosage to be administered is Click Here

8) Order: 1.25 milligrams of a medication. On hand is 0.25 milligrams in 5 milliliters of the medication. Give Click Here

2 tablets

3 tablets

10 milliliters or 10 mL

25 milliliters or 25 mL

9) The pharmacy has 15 milligram tablets on the shelf. Dr. Smith orders 30 milligrams of Phenobarbital. The patient will receive _________________________ Click Here

10) Read the prescription, look at the vial, and calculate the drug order.

2 tablets

Phone 206-888-9999 DEA# 54699999

Mori Chisata, MD

Pt. name Tommy Smart Age 22 Date May 5, 2008

Address: 23 Roosevelt Way, Seattle, WA 98567

RX Neurontin 375 mg p.o. tid x 7 days

Refill _0_ _ _Generic and/or equivalent allowed

Physician’s SignatureMoriChisata, MD

Lake View Medical Center,

125 Bridge Blvd. S., Seattle, WA 98655

10) cont.

Set up your formula: ______________ x __________ = ____________

The individual dose .