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Medication Reconstitution

. Injectable medications May be unstable in solutionPackaged in powder form.

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Medication Reconstitution

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    1. Medication Reconstitution VN230 – CHD-1

    2. Injectable medications May be unstable in solution Packaged in powder form.  Package or label directions must be followed Amount and type of diluent to use Strength of the prepared solution Proper storage after reconstitution Length of time the preparation can be safely used Reconstituting powdered drugs: Read the label for the amount of fluid to add, the type of fluid and the final concentration of the reconstituted fluid. The label will also tell you how long the mixture may be stored and what conditions are required for storage.  The final volume will be larger than the amount of fluid you add because the powder will take up some room when diluted. If you are not given a final volume calculate the concentration based on the amount of fluid you added. You will calculate the amount to administer from the final concentration. http://classes.kumc.edu/son/nurs420/clinical/basic_review.htm Injectable medications that may be unstable in solution, are packaged in powder form.  All package or label directions must be followed exactly.  These directions will specify the amount and type of diluent to use, and the strength of the prepared solution.  Other information, like proper storage after reconstitution and the length of time the preparation can be safely used is also included.  In a multi-dose vial, it is essential that the nurse mark on the container the date and time of preparation, the strength of the resulting solution, the expiration of potency, storage directions and his/ her initials. Some package directions list several preparation methods to yield different strengths of medication. The nurse should select the strength closest tot eh ordered dose and should consider the number of injections required for administration.  If possible, the ordered dose should be administered in one injection.  The patient age, body weight and build and injection site for administration must all be considered when reconstituting powdered medications. http://home.sc.rr.com/nurdosagecal/Parenteral%20Dosages.htmReconstituting powdered drugs: Read the label for the amount of fluid to add, the type of fluid and the final concentration of the reconstituted fluid. The label will also tell you how long the mixture may be stored and what conditions are required for storage.  The final volume will be larger than the amount of fluid you add because the powder will take up some room when diluted. If you are not given a final volume calculate the concentration based on the amount of fluid you added. You will calculate the amount to administer from the final concentration. http://classes.kumc.edu/son/nurs420/clinical/basic_review.htm Injectable medications that may be unstable in solution, are packaged in powder form.  All package or label directions must be followed exactly.  These directions will specify the amount and type of diluent to use, and the strength of the prepared solution.  Other information, like proper storage after reconstitution and the length of time the preparation can be safely used is also included.  In a multi-dose vial, it is essential that the nurse mark on the container the date and time of preparation, the strength of the resulting solution, the expiration of potency, storage directions and his/ her initials. Some package directions list several preparation methods to yield different strengths of medication. The nurse should select the strength closest tot eh ordered dose and should consider the number of injections required for administration.  If possible, the ordered dose should be administered in one injection.  The patient age, body weight and build and injection site for administration must all be considered when reconstituting powdered medications. http://home.sc.rr.com/nurdosagecal/Parenteral%20Dosages.htm

    3. Package directions may list several preparation methods to yield different strengths of medication Select the strength closest to the ordered dose Consider the number of injections required for administration The ordered dose should be administered in one injection   100,000 units   =   150,000 units          1 mL                   X mL     100,000 X  = 150,000      100,000 X  =  150,000    100,000          100,000         X  =   1.5 mL HINT:  Once you have your problem set up, reduce numbers as possible so that your arithmatic work is easier, especially when you are working problem without a calculator.  In the above problem, crossing out equal numbers of zero's from the top and bottom, you are left with 15 divided by 10.  This will be much easier arithmatic. When reviewing the reconstitution instructions, sometimes the manufacturer will give you only one way to mix the medication (as in the above example, add 4.8 mL to mix); however, frequently the manufacturer will give several options on the amount of dilutent to add.  In this situation, you choose one of the options and proceed with working the problem.  The only restrictions on the choice will depend on the final answer and the route of administration for the medication.  RULES:  For an intramuscular (IM) injection in an adult, the final dose amount should not exceed 3 mL for a  single injection in the buttocks and 1 mL in the arm.  For a subcutaneous (SC) injection, the maximum amount is 1 mL, preferably less.  The maximim amounts in children will vary based on the age/size of the child.   If you chose a dilutent amount that gave you an answer in excess of the maximum amount allowed, you would need to choose a more concentrated solution that would give you a smaller amount to give. Example problem#2:  Orderd is penicillin 600,000 units IM.  You have a vial of penicillin powder containing twenty million units.  Reconstitute with _________   and give ___________.   100,000 units   =   150,000 units         1 mL                   X mL

    4. Med may come with its own liquid for mixing and if this is the case, that liquid must be used.   If liquid not provided, label will advise if there are any restrictions regarding the liquid to use.  Most Commonly the liquid used is either sterile normal saline or sterile bacteriostatic water Pharmacy Floor stock   Powders designed for oral use may be able to be reconstituted with tap water. Instructions on the vial include the following:    mL diluent added           approx units per mL of solution        75 mL                             250,000 u/mL        33 mL                             500,000 u/mL      11.5 mL                          1,000,000 u/mL Choose one of the above options and set up the ratio and solve. If you choose to reconstitute with 75 mL, you would have the following ratio:     250,000 units    =    600,000 units            1 mL                      X mL         250,000 X   =  600,000                      X  =  2.4 mL This is less than 3 mL so it is an acceptable choice.  In the blanks in the problem you would fill in as follows:  Reconstitute with    75 mL   and give   2.4 mL. {For this problem, any of the given reconstitution options would be acceptable because each option would give you an amount to administer of less than 3 mL.}

    5. Main Components of a Label How to store the medication. NDC number identifies the product. Name of the medication. Some labels will have both Brand (Trade) name and generic name. Concentration of the medication in the vial. Total amount of diluent Unit dose of medication How much liquid is in the vial after proper reconstitution. How the medication should be administered Usual dose of the medication. Batch from which medication was taken from. The last date the medication can be safely used. Name of pharmaceutical company who manufactured medication. NOTE:   You can reconstitute only with a liquid.  On a dosage test, if you put 250.000 units/mL in the "reconstitute with" blank, it will be wrong.  The 250,000 units/mL is the final concentration you end up with after you have followed the instructions of adding 75 mL of liquid to mix the powder. Chapter 9 in the drug dosage workbook relates to reconstitution of powdered drugs.  You are strongly encouraged to use the workbook and practice with these problems as students commonly have a little more difficulty with reconstitution problems. http://www.polk.edu/Instruct/Mash/annette_h/NUR%201140C/ReconstitutingPowderMedications.html Main Components of a Label How to store the medication. Some medication labels will also indicate how to store the medication after it has been reconstituted. NDC number identifies the product. Name of the medication. Some labels will have both Brand (Trade) name and generic name. Concentration of the medication in the vial. Unit dose of medication How much liquid is in the vial after proper reconstitution. How the medication should be administered after reconstitution. Usual dose of the medication. Batch from which medication was taken from. The last date the medication can be safely used. Some medication labels will also indicate shelf life after reconstitution. Name of pharmaceutical company who manufactured medication. Continue on for examples on how to read a medication label in order to help you see and understand the concepts we have discussed. NOTE:   You can reconstitute only with a liquid.  On a dosage test, if you put 250.000 units/mL in the "reconstitute with" blank, it will be wrong.  The 250,000 units/mL is the final concentration you end up with after you have followed the instructions of adding 75 mL of liquid to mix the powder.

    6. Multi-dose vial mark on the container Date and time of preparation Strength of the resulting solution Expiration of potency Storage directions Initials Some medications are available in powder form and are too unstable to mix until ready for use. Mixing the powder is called reconstituting the powder.   Sometimes a med will come with its own liquid for mixing and if this is the case, that liquid must be used.   If a liquid is not provided with the medication, the label will advise if there are any restrictions regarding the liquid to use.  Most commonly for parenteral medications the liquid used is either sterile normal saline or sterile bacteriostatic water and the pharmacy will provide you with a vial of one of these to use.  Some powders designed for oral use may be able to be reconstituted with tap water. The manufacturer will provide instructions regarding the type and amount of diluent (the liquid) to add and information regarding the concentration of the medication if it is mixed according to those directions.  The instructions may appear on the vial/bottle of powder of they may be given as a package insert.  For safe administration of these medications, it is essential that you follow these manufacturer's instructions.  Example instructions:  add 3.8 mL sterile water to yield 500 mg/mL.; add 10 mL normal saline, results in 200,000 U per 5 mL. To calculate a dosage using a reconstituted powder, the left hand side of your ratio should always be the final concentration of medication after the powder is mixed. Example problem #1:  The physician orders 150,000 units of Penicillin.  You have a 10 cc vial of powder labeled Penicillin 500,000 units.  Instructions indicate to add 4.8 mL sterile saline or sterile water to give 100,000 units per mL.  Reconstitute with ________ and give ________. In this example problem, it does not matter that it is a 10 cc vial; it does not matter that the vial contains a total of 500,000 units of penicillin.  The information that you will use is that you will reconstitute with 4.8 mL (which goes in the 1st blank).  Following these instructions would give you 100,000 units in each mL.  This becomes the left-hand side of the ratio.  Some medications are available in powder form and are too unstable to mix until ready for use. Mixing the powder is called reconstituting the powder.   Sometimes a med will come with its own liquid for mixing and if this is the case, that liquid must be used.   If a liquid is not provided with the medication, the label will advise if there are any restrictions regarding the liquid to use.  Most commonly for parenteral medications the liquid used is either sterile normal saline or sterile bacteriostatic water and the pharmacy will provide you with a vial of one of these to use.  Some powders designed for oral use may be able to be reconstituted with tap water.

    7. Practice How is the med stored? What is the NDC number? What is the name of the medication? Concentration of the medication in the vial? Total amount of diluent? Unit dose of medication? How much liquid is in the vial after proper reconstitution? How the medication should be administered? Usual dose of the medication? Batch from which medication was taken? The last date the medication can be safely used? Name of manufacturer? What is reconstitution It is Saturday afternoon and you are studying for finals when you get a sudden craving for brownies. On the back of box you read the given directions, or recipe, on how to turn the brownie powder inside the box into yummy liquid brownie batter: Add 3 tablespoons vegetable oil Add 2 tablespoons water Add one egg By following the given directions on the back of the box, you have in actuality completed the process of reconstitution. You have dissolved the brownie powder by using three diluents (oil, water, and an egg) to make a liquid brownie batter. Like the brownie powder, medications are also available in a dry form – powders and crystals. The dry medication is available in three common containers: a glass vial, a glass ampule, and a plastic bottle. The container is to medications what the box is to the brownie mix. The container containing the powdered medications will have directions, or recipe, on the label on how to properly reconstitute the medication. Before reconstituting a medication, it is important to thoroughly read the medication label on the container. Medication Label The medication label is like the outside of the brownie box. The brownie box tells you the name of the company who makes the brownie mix, the ingredients, the latest date to use the brownie mix, and how to mix the ingredients. The medication label provides much of the same information: Name of the medication - Brand and/or generic name Quantity of medication in the vial Concentration of Medication Directions on how to properly reconstitute the medication Expiration date Proper administartion - IM, IV, SC, ect. Name of the pharmaceutical company who makes the medication What is reconstitution It is Saturday afternoon and you are studying for finals when you get a sudden craving for brownies. On the back of box you read the given directions, or recipe, on how to turn the brownie powder inside the box into yummy liquid brownie batter: Add 3 tablespoons vegetable oil Add 2 tablespoons water Add one egg By following the given directions on the back of the box, you have in actuality completed the process of reconstitution. You have dissolved the brownie powder by using three diluents (oil, water, and an egg) to make a liquid brownie batter. Like the brownie powder, medications are also available in a dry form – powders and crystals. The dry medication is available in three common containers: a glass vial, a glass ampule, and a plastic bottle. The container is to medications what the box is to the brownie mix. The container containing the powdered medications will have directions, or recipe, on the label on how to properly reconstitute the medication. Before reconstituting a medication, it is important to thoroughly read the medication label on the container. Medication Label The medication label is like the outside of the brownie box. The brownie box tells you the name of the company who makes the brownie mix, the ingredients, the latest date to use the brownie mix, and how to mix the ingredients. The medication label provides much of the same information: Name of the medication - Brand and/or generic name Quantity of medication in the vial Concentration of Medication Directions on how to properly reconstitute the medication Expiration date Proper administartion - IM, IV, SC, ect. Name of the pharmaceutical company who makes the medication

    8. On the following drug label, identify the routes for administration for which this preparation can be used. 

    9. After reconstitution with 2.5 mL diluent, the strength of the Kefzol solution is 330 mg/ mL.            To administer a dose of  500 mg, how many mL would you give?

    10. Order: Prostaphlin 500 mg IM q6h Label reads: Give ________ mL

    11. Order: Ticar 500 mg IM stat and q8h Label reads: How many mL would be given?

    12. Questions??? Picture of the recipe on the back a of a brownie box recipe =Picture of a medication vial with label with the directions on how to mix the medication. Vial should have a powder in it. Medications are packaged in a dry form so that they can be stored for a longer period of time. The dry form of medication may come from the pharmacy or may be kept in a medication system on the nursing unit. A pharmacist or other health professional will need to reconstitute the medication so that it can be administered to the patient. After a medication has been reconstituted, it can be stored only for a short time before it can no longer be used. The length of time a liquid medication, or any medication, can be stored safely is known as the shelf life (link term to glossary in new window) of a medication. The medication label will have an expiration date on it and will indicate how long the shelf life is after it has been reconstituted. Additionally, the medication label will indicate the concentration (link term to glossary in new window) after reconstitution. For example, 250 mg/5 mL or 10,000 U/mL. http://www.calculated-success.org/module.aspx?modid=12&page=2 Picture of the recipe on the back a of a brownie box recipe =Picture of a medication vial with label with the directions on how to mix the medication. Vial should have a powder in it. Medications are packaged in a dry form so that they can be stored for a longer period of time. The dry form of medication may come from the pharmacy or may be kept in a medication system on the nursing unit. A pharmacist or other health professional will need to reconstitute the medication so that it can be administered to the patient. After a medication has been reconstituted, it can be stored only for a short time before it can no longer be used. The length of time a liquid medication, or any medication, can be stored safely is known as the shelf life (link term to glossary in new window) of a medication. The medication label will have an expiration date on it and will indicate how long the shelf life is after it has been reconstituted. Additionally, the medication label will indicate the concentration (link term to glossary in new window) after reconstitution. For example, 250 mg/5 mL or 10,000 U/mL. http://www.calculated-success.org/module.aspx?modid=12&page=2

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