#whumpsmith | Explore Tumblr Posts and Blogs

macgyvermedical · 8 months

Text

Drug Orders and Doses

@whumpsmith

Cool, so I think the first thing to know is how medication is ordered.

Generally speaking, it will be ordered in 5 parts, known as the "5 Rights" of medication administration:

#1 What patient is getting the medication

#2 What medication is to be given

#3 How much medication is to be given

#4 What time it is to be given (or how often)

#5 What route it is to be given

So an order might be "Give John Smith (5/13/1995) lorazepam 0.5mg IV once prior to MRI"

In this example, John Smith is the patient and 5/13/1995 is his birthday to differentiate him from all the other John Smiths. "Lorazepam" is the drug's generic name, "0.5mg" is the amount of the drug. "IV" is the route, and "once prior to MRI" is the time.

Drugs have generic and brand names. For example, acetaminophen is a generic name. Many companies make acetaminophen, and each has their own brand name for the drug. Probably the most well-known brand name for acetaminophen is Tylenol, but there are others, like Calpol and Panadol. For most people, it doesn't matter which brand of a particular drug is used, just that the active ingredient (the generic name) is the same. For some people it matters because the non-active ingredients may be different between brands, and they may be allergic to a non-active ingredient that is in one brand, but not another.

In a hospital setting, we're going to use the generic name, because the brand of the drug that is cheapest to the hospital pharmacy varies contract to contract, and there are a lot of drug shortages these days. That's why if you're in the hospital you might get an oval green pill one day and a round white one the next day. They're the same drug, just different brands.

The dose is given in milligrams, usually abbreviated "mg". Milligrams are a measure of weight. Cubic centimeter (cc), on the other hand is a measure of volume. At some point we switched from volume based to weight based measures because we had a lot of different concentrations and using volumes for everything made mistakes really common. If you're using weights, it doesn't matter if the concentration you have is 1mg/mL or 10mg/mL for a given drug, you can do the math and come up with a volume that is right instead of just hoping you picked the one the doctor was thinking about when they wrote the order.

There are many routes a drug can take into the body. There is oral (a pill or liquid), IV (injection in a vein), IM (injection in a muscle), SQ (injection into fat), rectal/PR (a suppository, gel, or liquid inserted into the rectum), SL (under the tongue), TD (a paste or patch that sends medication through the skin) and many more.

Times can be once, once every x hours, once every x hours as needed (PRN), once under a particular circumstance, daily, or pretty much any other interval you can think of. "Stat" is a term meaning "right now".

Here's a list of common medications and their dosages:

CODE DRUGS:

Epinephrine 1mg IV for cardiac arrest every 3-5 minutes, 0.3mg for anaphylaxis

Amiodarone 150-300mg IV over 10 minutes for cardiac arrest

Lidocaine 75mg for cardiac arrest initially, if that doesn't work then 37.5 10 mins later

Adenosine 6mg given very quickly for PSVT, if that doesn't work, give 12mg

Atropine 1mg every 3-5 minutes for low heart rate until heart rate is normal

OTHER DRUGS:

Albuterol 2.5mg in nebulizer for brochospasm/asthma attack

Metoprolol 5mg IV every 5 minutes up to 15mg for severe high blood pressure

Furosemide 20-80mg IV for fluid on lungs

D50 25g IV for low blood sugar

Diphenhydramine 12.5-50mg IV for allergic reaction

Morphine 2-10mg IV or IM for pain

Fentanyl 50-200mcg for sedation

Mannitol 20-150g for increased pressure inside the skull

Nitroglycerin 0.3-0.6mg every 5 minutes up to 3 times for chest pain (angina)

Naloxone 8mg nasal spray every 2-3 minutes for opioid overdose

Flumazenil 0.2mg IV for benzodiazepine poisoning, if that doesn't work give 0.3mg, if that doesn't work, give 0.5

Diazepam 15mg rectal gel for seizures that don't stop

Phenobarbital 1-1.5g IV for seizures that don't stop

Etomidate 22mg IV for anesthesia (for things like intubating someone)

Midazolam 5mg IV for sedation prior to surgery

Olanzepine 5-10mg IV for agitation (emergency sedation)

Haloperidol 0.5-10mg oral or IM for agitation (emergency sedation)

#whump reference #writing reference #drugs #whump #medical orders #sedation #anaphylaxis #cardiac arrest #pain

122 notes · View notes